Individual
CARLY NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5435 FELTL RD, MINNETONKA, MN 55343-7983
(952) 835-9880
Mailing address
5435 FELTL RD, MINNETONKA, MN 55343-7983
(952) 835-9880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11656
MN
363AM0700X
Medical Physician Assistant
085004730
IL
Other
Enumeration date
09/13/2013
Last updated
01/27/2017
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