Healthcare Provider Details

I. General information

NPI: 1710218151
Provider Name (Legal Business Name): SHEILA KATHLEEN SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 S 3RD ST
MINNEAPOLIS MN
55415
US

IV. Provider business mailing address

814 S 3RD ST
MINNEAPOLIS MN
55415
US

V. Phone/Fax

Practice location:
  • Phone: 612-888-9792
  • Fax: 612-888-9762
Mailing address:
  • Phone: 612-888-9792
  • Fax: 612-888-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8039444
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number80289 -030
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5091
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: