Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN180176 | GA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN180176 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN180176 | GA |
NPI | 1053711747 |
---|---|
Provider Name | Mrs. Amy Saulsby-Smith |
First Address | Minneapolis, MN 55440-1459 |
Second Address | Minnetonka, MN 55343-9664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003162549A | (05) | GA |
ARNP3397912 | FLNP LICENSE (01) | FL |
RN180176 | GA LICENSE (01) | GA |
RN3397912 | FL RN LICENSE (01) | FL |