Doctor Name: | TAMARA SMITH |
NPI Number: | 1417364944 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | F06141301 |
Business Practice Address: | 40520 County Highway 34 Ogema, MN - 565699612 |
Business Phone Number: | 2189834300 |
Business Fax Number: | |
Mailing Address: | 1124 4th Ave N, SAUK RAPIDS |
State: | MN |
Postal Code: | 56379 |
Phone Number: | 3202918773 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2014 |
NPI Last Update Date: | 07/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F06141301 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |