=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700802279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH K.L. SMITH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 08/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9900 BREN RD E
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55343-9664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-800-2894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10808 N HIGHLAND CIR
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-9020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-800-2894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5291605-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------