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NPI Code Detail

MEDICARE: COREEN S SMITH CNP, MS

MEDICARE: COREEN S SMITH CNP, MS
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
1363LW0102XWomen's Health Nurse PractitionerCNP 1337MN

General Provider Information

NPI Number : 1548353469
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREEN S SMITH CNP, MS
Provider Business Mailing Address
First Line : 2603 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5110
Country : US
Telephone Number : 651-600-3035
Fax Number : 651-348-8783
Provider Business Practice Location Address
First Line : 2603 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5110
Country : US
Telephone Number : 651-600-3035
Fax Number : 651-348-8783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 04/19/2021

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