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Ms. Carrie Susan Smith

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NPI Number Detailed Information

Provider Information:

Name: Ms. Carrie Susan Smith
Gender: F
Provider License Number If Given: R160154-7

NPI Information:

NPI: 1437143955
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 1/19/2009

Provider Business Mailing Address:

Address: 13176 MARIGOLD ST NW
Coon Rapids, MN 55448
Phone Number: 7637125695
Fax Number:

Provider Business Practice Location Address:

Address: 333 WASHINGTON AVE N SUITE 5000
Minneapolis, MN 55401
Phone Number: 7637125974
Fax Number:

Provider Taxonomy:

Primary: 363L00000X
Secondary (if any):
State: MN

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