Individual
ANGELA KATHLEEN SMACIARZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 780-8155
Mailing address
2925 CHICAGO AVENUE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 188589-7
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP 3712
MN
363LG0600X
Gerontology Nurse Practitioner
CNP 3712
MN
Other
Enumeration date
02/13/2015
Last updated
03/26/2021
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