Provider Demographics
NPI:1467028019
Name:SMITH, MACEE NOELLE (CNP)
Entity Type:Individual
Prefix:
First Name:MACEE
Middle Name:NOELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOYLETON
Mailing Address - State:IL
Mailing Address - Zip Code:62803-2000
Mailing Address - Country:US
Mailing Address - Phone:618-918-7777
Mailing Address - Fax:618-918-7782
Practice Address - Street 1:28 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOYLETON
Practice Address - State:IL
Practice Address - Zip Code:62803-2000
Practice Address - Country:US
Practice Address - Phone:618-791-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily