Provider Demographics
NPI:1902444979
Name:USMANOVA, NAZIRA
Entity type:Individual
Prefix:
First Name:NAZIRA
Middle Name:
Last Name:USMANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2760
Mailing Address - Country:US
Mailing Address - Phone:402-680-1802
Mailing Address - Fax:402-939-0057
Practice Address - Street 1:14080 BOYS TOWN HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7513
Practice Address - Country:US
Practice Address - Phone:531-355-7420
Practice Address - Fax:531-355-6921
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77760163W00000X
NE112861363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily