Individual
MS. SUSAN FAYE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC,FNP
Contact information
Practice address
104 N PARK ST, NORTHWOOD, ND 58267-4103
(701) 587-6602
(701) 587-6009
Mailing address
PO BOX 160, NORTHWOOD, ND 58267-0160
(701) 587-6000
(701) 587-6009
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R181514-2
MN
363LF0000X
Family Nurse Practitioner
Primary
R34545
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174502058
ND BCBS
ND
01
—
1174502058
TRICARE
—
05
—
1174502058
—
MN
05
—
84039
—
ND
Enumeration date
01/10/2006
Last updated
04/01/2011
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