MEDICARE: AMY SMITH RN, PHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R142669-6	MN

General Provider Information

NPI Number	:	1356212237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SMITH RN, PHN

Provider Business Mailing Address
First Line	:	1575 MINERAL SPRINGS RD
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-2067
Country	:	US
Telephone Number	:	507-535-2598
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 BROADWAY AVE S
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-6445
Country	:	US
Telephone Number	:	507-457-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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