| NPI | 1578819744 |
|---|---|
| Former Name | STEPHANIE LYN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2936) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1746910) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-08-07 |