| Doctor Name: | STEPHANIE SMITH |
| NPI Number: | 1134559610 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | R1908376 |
| Business Practice Address: | 7115 Forthun Road Suite 105 Baxter, MN - 56425 |
| Business Phone Number: | 2184540090 |
| Business Fax Number: | 2184540091 |
| Mailing Address: | 7115 Forthun Road, Suite 105 BAXTER |
| State: | MN |
| Postal Code: | 56425 |
| Phone Number: | 2184540090 |
| Fax Number: | 2184540091 |
| NPI Enumeration Date: | 11/19/2013 |
| NPI Last Update Date: | 08/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | R1908376 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |