Provider Demographics
NPI:1013210962
Name:SMITH, REGINALD BERNARD (RN)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:BERNARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-5328
Mailing Address - Country:US
Mailing Address - Phone:402-476-7544
Mailing Address - Fax:
Practice Address - Street 1:7031 HELEN WITT DR
Practice Address - Street 2:APT 1001
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3623
Practice Address - Country:US
Practice Address - Phone:402-420-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58043163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse