Healthcare Provider Details

I. General information

NPI: 1386630051
Provider Name (Legal Business Name): MARY BETH SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

IV. Provider business mailing address

302 W PHILLIP AVE
NORFOLK NE
68701-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-8000
  • Fax: 402-371-0971
Mailing address:
  • Phone: 402-371-8000
  • Fax: 402-371-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number53411
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number111255
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: