Individual
MARY M. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
920 2ND AVE S, SUITE 400, MINNEAPOLIS, MN 55402-3318
(516) 322-1591
Mailing address
920 2ND AVE S, SUITE 400, MINNEAPOLIS, MN 55402-3318
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F332178-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02104401
—
NY
01
—
95N642
BLUECROSS BLUESHIELD
NY
Enumeration date
12/29/2005
Last updated
02/12/2008
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