Provider Demographics
NPI:1942832787
Name:SMITH, NIKKO M (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:NIKKO
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0146
Mailing Address - Country:US
Mailing Address - Phone:970-305-0693
Mailing Address - Fax:
Practice Address - Street 1:204 NORTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331
Practice Address - Country:US
Practice Address - Phone:970-305-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY29096251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management