Provider Demographics
NPI:1902661572
Name:SMITH, RYLEE CHANTEL (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:CHANTEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:RYLEE
Other - Middle Name:CHANTEL
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 30TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-3036
Mailing Address - Country:US
Mailing Address - Phone:320-841-1396
Mailing Address - Fax:
Practice Address - Street 1:825 NICOLLET MALL STE 556
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2603
Practice Address - Country:US
Practice Address - Phone:844-670-2273
Practice Address - Fax:833-471-4119
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11295363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology