Provider Demographics
NPI:1114432853
Name:SMITH, LINDA MAE (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:MAE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6012 N 102ND ST.
Mailing Address - Street 2:UNIT #34114
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1031
Mailing Address - Country:US
Mailing Address - Phone:402-651-2923
Mailing Address - Fax:
Practice Address - Street 1:5620 AMES AVE.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2702
Practice Address - Country:US
Practice Address - Phone:402-933-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERN47227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse