Provider Demographics
NPI:1770187304
Name:SMILEY, DAVID DEWITT (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEWITT
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 BRICKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8639
Mailing Address - Country:US
Mailing Address - Phone:708-525-1895
Mailing Address - Fax:
Practice Address - Street 1:1763 BRICKVILLE RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-8639
Practice Address - Country:US
Practice Address - Phone:708-525-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily