Provider Demographics
NPI:1669904983
Name:SMITH, NANCY IMIG (LAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:IMIG
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:KAY
Other - Last Name:IMIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:770 N COTNER BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2344
Mailing Address - Country:US
Mailing Address - Phone:402-480-6044
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2344
Practice Address - Country:US
Practice Address - Phone:402-480-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE45171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist