Healthcare Provider Details

I. General information

NPI: 1073979951
Provider Name (Legal Business Name): ZIPNOSIS DIAGNOSTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 1ST AVE N SUITE 200
MINNEAPOLIS MN
55401-1608
US

IV. Provider business mailing address

248 1ST AVE N SUITE 200
MINNEAPOLIS MN
55401-1608
US

V. Phone/Fax

Practice location:
  • Phone: 763-639-5327
  • Fax:
Mailing address:
  • Phone: 763-639-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR96446-3
License Number StateMN

VIII. Authorized Official

Name: DR. KEVIN LEE SMITH
Title or Position: PRESIDENT, CHIEF CLINICAL OFFICER
Credential: DNP, FNP
Phone: 763-639-5327