Individual
ELISA M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNS
Contact information
Practice address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
275
MN
363LC0200X
Critical Care Medicine Nurse Practitioner
275
MN
364S00000X
Clinical Nurse Specialist
Primary
CNS 0275
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0423194
—
IA
01
—
55721
WELLMARK BCBS
IA
Enumeration date
09/30/2005
Last updated
11/08/2021
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