Individual
SHANNON MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7000
Mailing address
8028 242ND AVE NE, STACY, MN 55079-9310
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
7892
MN
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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