Provider Demographics
NPI:1205362472
Name:SMITH, ORAPHANH VONGPHETH (RN)
Entity Type:Individual
Prefix:
First Name:ORAPHANH
Middle Name:VONGPHETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TWELVE OAKS CENTER DRIVE
Mailing Address - Street 2:SUITE 822
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-456-6561
Mailing Address - Fax:952-777-1668
Practice Address - Street 1:801 TWELVE OAKS CENTER DRIVE
Practice Address - Street 2:SUITE 822
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-456-6561
Practice Address - Fax:952-777-1668
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN222678-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN222678-5OtherREGIESTER NURSE