Healthcare Provider Details

I. General information

NPI: 1013210962
Provider Name (Legal Business Name): REGINALD BERNARD SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 HELEN WITT DR APT 1001
LINCOLN NE
68512-3623
US

IV. Provider business mailing address

5445 NW 4TH ST
LINCOLN NE
68521-5328
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7706
  • Fax:
Mailing address:
  • Phone: 402-476-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number58043
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: