Provider Demographics
NPI:1063957348
Name:SMITH, JOYCE L (APN)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5569
Mailing Address - Country:US
Mailing Address - Phone:630-789-9785
Mailing Address - Fax:630-789-9798
Practice Address - Street 1:25 N WINFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1222
Practice Address - Country:US
Practice Address - Phone:630-232-0202
Practice Address - Fax:630-690-2293
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.015151363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily