Provider Demographics
NPI:1609504604
Name:SMITH-BORDIANU, JULIA ANNA MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNA MARIE
Last Name:SMITH-BORDIANU
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19603 WEIR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3811
Mailing Address - Country:US
Mailing Address - Phone:402-677-4958
Mailing Address - Fax:
Practice Address - Street 1:1870 S 75TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1700
Practice Address - Country:US
Practice Address - Phone:402-361-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE150119376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty