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NPI Code Detail

MEDICARE: WILTHELLA C SMITH

MEDICARE: WILTHELLA C SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1033003389
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILTHELLA C SMITH
Provider Business Mailing Address
First Line : 4415 N 60TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68104-2714
Country : US
Telephone Number : 402-403-7672
Fax Number :
Provider Business Practice Location Address
First Line : 4415 N 60TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68104-2714
Country : US
Telephone Number : 402-403-7672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2025
Last Update Date : 06/03/2025

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Directions to “ WILTHELLA C SMITH ” Practice Location

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