MEDICARE: NICHOLE SMITH APRN WHNP

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	363LW0102X	Women's Health Nurse Practitioner	115396	NE

General Provider Information

NPI Number	:	1598506040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE SMITH APRN WHNP

Provider Business Mailing Address
First Line	:	1055 COTTONWOOD ST
Second Line	:
City	:	BENNET
State	:	NE
Zip	:	68317-2427
Country	:	US
Telephone Number	:	402-570-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	5631 S 48TH ST STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4107
Country	:	US
Telephone Number	:	877-859-0587
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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