Healthcare Provider Details

I. General information

NPI: 1962208009
Provider Name (Legal Business Name): RAEANNE SMIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41147 377TH AVE
SAINT PETER MN
56082-4029
US

IV. Provider business mailing address

41147 377TH AVE
SAINT PETER MN
56082-4029
US

V. Phone/Fax

Practice location:
  • Phone: 507-766-9556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: