Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1082 | MN |
N | 213ES0103X | Foot & Ankle Surgery | PDT.0000538 | CO |
NPI | 1366853715 |
---|---|
Provider Name | Abigail Smith |
First Address | Albert Lea, MN 56007-2044 |
Second Address | Albert Lea, MN 56007-2044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13663853715 | (05) | MO |