Provider Demographics
NPI:1881638054
Name:SMETANKA, JOY M (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:SMETANKA
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:M
Other - Last Name:DALAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD,CDE
Mailing Address - Street 1:12912 HIGHCLERE DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3733
Mailing Address - Country:US
Mailing Address - Phone:952-212-7445
Mailing Address - Fax:
Practice Address - Street 1:6939 PINE ARBOR DR S STE 100
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4643
Practice Address - Country:US
Practice Address - Phone:651-326-5800
Practice Address - Fax:651-326-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1928163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1881638054Medicaid
MN1881638054OtherNPI