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NPI Code Detail

MEDICARE: JOY M SMETANKA RD, LD, CDE

MEDICARE: JOY M SMETANKA RD, LD, CDE
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
1163WD0400XDiabetes Educator Registered Nurse1928MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21881638054OTHERMNNPI

General Provider Information

NPI Number : 1881638054
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOY M SMETANKA RD, LD, CDE
Provider Business Mailing Address
First Line : 12912 HIGHCLERE DR
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-3733
Country : US
Telephone Number : 952-212-7445
Fax Number :
Provider Business Practice Location Address
First Line : 6939 PINE ARBOR DR S STE 100
Second Line :
City : COTTAGE GROVE
State : MN
Zip : 55016-4643
Country : US
Telephone Number : 651-326-5800
Fax Number : 651-326-5802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 05/19/2019

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