Healthcare Provider Details

I. General information

NPI: 1902444979
Provider Name (Legal Business Name): NAZIRA USMANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14080 BOYS TOWN HOSPITAL RD
BOYS TOWN NE
68010-7513
US

IV. Provider business mailing address

12313 GOLD ST
OMAHA NE
68144-2760
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-7420
  • Fax: 531-355-6921
Mailing address:
  • Phone: 402-680-1802
  • Fax: 402-939-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77760
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112861
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112861
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number112861
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: