Individual
MS. SUSAN MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R0874443
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43910700
—
WI
05
—
477417500
—
MN
Enumeration date
12/22/2005
Last updated
02/14/2011
Update your record
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