Provider Demographics
NPI:1356697304
Name:SMITH, CHRISTOPHER RONDALL (DOCTOR NSG PRACTICE)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RONDALL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DOCTOR NSG PRACTICE
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1459
Mailing Address - Country:US
Mailing Address - Phone:949-303-8582
Mailing Address - Fax:
Practice Address - Street 1:UNITEDHEALTH CARE
Practice Address - Street 2:9800 HEALTH CARE LN
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-992-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0990962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily