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General NPI Number Information
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NPI Number | 1881638054
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Entity Type | Individual
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Provider Name | JOY M SMETANKA RD, LD, CDE
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 05/19/2019
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Provider Practice Location Address
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Address Line | 6939 PINE ARBOR DR S STE 100
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4643
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Country | US
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Telephone | 651-326-5800
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Fax | 651-326-5802
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Provider Business Mailing Address
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Address Line | 12912 HIGHCLERE DR
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City | BURNSVILLE
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State | MN
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Zip | 55337-3733
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Country | US
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Telephone | 952-212-7445
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 1928
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License Number State | MN
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