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General NPI Number Information
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NPI Number | 1649617762
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Entity Type | Individual
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Provider Name | TRACY DARLENE SMART
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Gender | Female
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 615 OAK ST
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City | BRAINERD
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State | MN
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Zip | 56401-3610
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Country | US
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Telephone | 218-454-2163
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 W RIVER RD
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City | DETROIT LAKES
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State | MN
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Zip | 56501-2722
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Country | US
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Telephone | 218-847-1388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | R 201849-8
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License Number State | MN
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