Provider Demographics
NPI:1992766786
Name:SMITH, JAIMEE (APN, CNP)
Entity type:Individual
Prefix:MS
First Name:JAIMEE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-677-4111
Mailing Address - Fax:847-677-3343
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-677-4111
Practice Address - Fax:847-677-3343
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005388363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005388Medicaid
ILK23929Medicare ID - Type UnspecifiedHIGHLAND PARK MEDICARE
ILQ34170Medicare UPIN