Healthcare Provider Details

I. General information

NPI: 1285607390
Provider Name (Legal Business Name): JENNIFER ELIZABETH SMITH-OTTE RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S 8TH ST SUITE 600
MINNEAPOLIS MN
55402-2841
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-4822
  • Fax:
Mailing address:
  • Phone: 612-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR1374395
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: