Individual
MARY JO SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 SMITH AVE N, SAINT PAUL, MN 55102-2344
(651) 735-0501
(651) 735-1870
Mailing address
2700 SNELLING AVE N, SUITE 400, ROSEVILLE, MN 55113-1719
(651) 697-5876
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R1099719
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
959542200
—
MN
Enumeration date
09/15/2006
Last updated
10/27/2014
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