Healthcare Provider Details

I. General information

NPI: 1164851457
Provider Name (Legal Business Name): JOHN SMETANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 ELBOWOOD LN
BISMARCK ND
58503-5712
US

IV. Provider business mailing address

P.O. BOX 391 825 S MAIN ST
TONOPAH NV
89049-0391
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-8260
  • Fax: 701-751-2463
Mailing address:
  • Phone: 775-482-6233
  • Fax: 775-482-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0572
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: