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NPI Code Detail

MEDICARE: ELISA M SMITH APRN, CNS

MEDICARE: ELISA M SMITH APRN, CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner275MN
2363LC0200XCritical Care Medicine Nurse Practitioner275MN
3364S00000XClinical Nurse SpecialistCNS 0275MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
155721OTHERIAWELLMARK BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164419644
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA M SMITH APRN, CNS
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 11/08/2021

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