Healthcare Provider Details

I. General information

NPI: 1942104229
Provider Name (Legal Business Name): YOLANDA RENEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 S 132ND ST
OMAHA NE
68137-1899
US

IV. Provider business mailing address

8112 S 92ND AVE
LA VISTA NE
68128-3203
US

V. Phone/Fax

Practice location:
  • Phone: 402-906-9612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: