Healthcare Provider Details
I. General information
NPI: 1851820773
Provider Name (Legal Business Name): JUSTIN MICHAEL SMITH DNP, CNS, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/05/2017
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1617 E DIVISION ST
RIVER FALLS WI
54022-1571
US
IV. Provider business mailing address
2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US
V. Phone/Fax
- Phone: 715-307-6600
- Fax:
- Phone: 612-262-9000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 11108 |
| License Number State | MN |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 356671 |
| License Number State | NY |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 7951-33 |
| License Number State | WI |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 7951-33 |
| License Number State | WI |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 2022030124 |
| License Number State | MO |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | W164201 |
| License Number State | IA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | AP61288318 |
| License Number State | WA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 538 |
| License Number State | MN |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 283150 |
| License Number State | AZ |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 202207448CNS-PP |
| License Number State | OR |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | R-212530-7 |
| License Number State | MN |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 974938 |
| License Number State | NY |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 185099 |
| License Number State | WI |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 202207051 |
| License Number State | OR |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
