Provider Demographics
NPI:1972270726
Name:SMITH, TERESA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNS-BC
Mailing Address - Street 1:17830 655TH AVE
Mailing Address - Street 2:
Mailing Address - City:DARWIN
Mailing Address - State:MN
Mailing Address - Zip Code:55324-7330
Mailing Address - Country:US
Mailing Address - Phone:320-221-0283
Mailing Address - Fax:
Practice Address - Street 1:218 N HOLCOMBE AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2257
Practice Address - Country:US
Practice Address - Phone:320-693-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0223364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health