Provider Demographics
NPI:1659142792
Name:SMITH, NICHOLAS R (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
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 1:6375 EDGERLY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9234
Mailing Address - Country:US
Mailing Address - Phone:701-204-2971
Mailing Address - Fax:701-751-4050
Practice Address - Street 1:418 E ROSSER AVE STE 104
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4046
Practice Address - Country:US
Practice Address - Phone:701-204-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47757163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy