Provider Demographics
NPI:1801851845
Name:MYRON SMITH, ANN V (CNNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:V
Last Name:MYRON SMITH
Suffix:
Gender:F
Credentials:CNNP
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE 35-121A
Mailing Address - Street 2:CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC - NICU
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6210
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MNR1622908363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Not Answered363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care