Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 46413 | MN |
NPI | 1043365984 |
---|---|
Provider Name | Angela Renee Smith |
First Address | Saint Paul, MN 55117-4348 |
Second Address | Minneapolis, MN 55455-0341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |