MEDICARE: LORI JEAN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	111110	NE

General Provider Information

NPI Number	:	1316278419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JEAN SMITH

Provider Business Mailing Address
First Line	:	203 CREST RD
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 S BURLINGTON AVE STE 108
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-6928
Country	:	US
Telephone Number	:	402-469-7711
Fax Number	:	402-461-5099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2010
Last Update Date	:	01/29/2010

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Directions to “ LORI JEAN SMITH ” Practice Location

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