Provider Demographics
NPI:1770579765
Name:SMITH, JENNIFER GESINE (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GESINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3092
Mailing Address - Country:US
Mailing Address - Phone:402-465-5600
Mailing Address - Fax:402-327-6074
Practice Address - Street 1:1336 W A ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1231
Practice Address - Country:US
Practice Address - Phone:402-465-5600
Practice Address - Fax:402-327-6074
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110489363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055126013Medicaid
276429Medicare ID - Type Unspecified
NE47055126013Medicaid