Healthcare Provider Details

I. General information

NPI: 1164800629
Provider Name (Legal Business Name): SHEREE SMITH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTH DR
EDEN PRAIRIE MN
55344-2955
US

IV. Provider business mailing address

1 HEALTH DR
EDEN PRAIRIE MN
55344-2955
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-0861
  • Fax:
Mailing address:
  • Phone: 800-561-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number271681
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number207012
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209025778
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19872
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number24196569
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP035186
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number19872
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: