# MARYELLEN T SMITH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1225004377
- **Gender:** F
- **Credential:** CPNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 0735016 | MN | — |
| 363LP0200X | Pediatric Nurse Practitioner | R073501-6 | MN | Yes |

## Other

- **Enumeration date:** 02/28/2006
- **Last updated:** 09/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 071742800 | — | MN |