Healthcare Provider Details

I. General information

NPI: 1356270698
Provider Name (Legal Business Name): OLIVIA GRACE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVERETT EMERY SMITH

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 VALLEY DR STE A
WAYNE NE
68787-2277
US

IV. Provider business mailing address

812 WINDOM ST APT G
WAYNE NE
68787-1401
US

V. Phone/Fax

Practice location:
  • Phone: 402-833-1080
  • Fax:
Mailing address:
  • Phone: 605-370-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: