Healthcare Provider Details

I. General information

NPI: 1023079423
Provider Name (Legal Business Name): LISA SMITH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA PAREDES CNM

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 CESAR CHAVEZ ST WESTSIDE COMMUNITY HEALTH SERVICES, INC.
W. ST. PAUL MN
55107-2226
US

IV. Provider business mailing address

153 CESAR CHAVEZ ST WESTSIDE COMMUNITY HEALTH SERVICES, INC.
W. ST. PAUL MN
55107-2226
US

V. Phone/Fax

Practice location:
  • Phone: 651-602-7552
  • Fax: 651-602-7580
Mailing address:
  • Phone: 651-602-7552
  • Fax: 651-602-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number124016-0
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNA9021019276
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerPREFERRED ONE
# 2
Identifier07-05977
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA
# 3
IdentifierHP24171
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerHEALTH PARTNERS
# 4
Identifier110675
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerUCARE
# 5
Identifier3F110NE
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBCBS
# 6
Identifier021765400
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: