Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R32606 | ND |
NPI | 1003477894 |
---|---|
Provider Name | Jessica Smolen |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58102-4550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 18/11/2021 |