Provider Demographics
NPI:1649471434
Name:SMITH, SARA E (APN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 W KUNKLE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6922
Mailing Address - Country:US
Mailing Address - Phone:815-233-0999
Mailing Address - Fax:815-233-7255
Practice Address - Street 1:3103 W KUNKLE BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6922
Practice Address - Country:US
Practice Address - Phone:815-233-0999
Practice Address - Fax:815-233-7255
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health