Provider Demographics
NPI:1548969637
Name:SMITH, AMELIA MARIE (RN)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27973 STATE HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:THEBES
Mailing Address - State:IL
Mailing Address - Zip Code:62990-2265
Mailing Address - Country:US
Mailing Address - Phone:573-820-2145
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041447040163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency