Individual
MARYELLEN T SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1900 CENTRACARE CIR #1300, CENTRACARE CLINIC - WOMEN'S AND CHILDRENS, ST CLOUD, MN 56303-5000
(320) 654-3610
(651) 702-5305
Mailing address
1900 CENTRACARE CIR #1300, CENTRACARE CLINIC - WOMEN'S AND CHILDRENS, ST CLOUD, MN 56303-5000
(320) 654-3610
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0735016
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
R073501-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071742800
—
MN
Enumeration date
02/28/2006
Last updated
09/07/2011
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