Healthcare Provider Details

I. General information

NPI: 1477512606
Provider Name (Legal Business Name): COURTNEY M. SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST #490
OMAHA NE
68131-2806
US

IV. Provider business mailing address

166 4TH ST E
SAINT PAUL MN
55101-1421
US

V. Phone/Fax

Practice location:
  • Phone: 402-504-3880
  • Fax: 402-504-3859
Mailing address:
  • Phone: 651-292-2043
  • Fax: 651-292-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number110716
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: