Provider Demographics
NPI:1518400308
Name:SMITH, CRYSTAL (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W CERMAK RD
Mailing Address - Street 2:STE. C-119
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4500
Mailing Address - Country:US
Mailing Address - Phone:312-243-2223
Mailing Address - Fax:312-243-8450
Practice Address - Street 1:1100 W CERMAK RD
Practice Address - Street 2:STE. C-119
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4500
Practice Address - Country:US
Practice Address - Phone:312-243-2223
Practice Address - Fax:312-243-8450
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily