Provider Demographics
NPI:1306076823
Name:SMITH-NELSON, NINA M (DPT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:SMITH-NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:M
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6418
Mailing Address - Fax:
Practice Address - Street 1:985450 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5450
Practice Address - Country:US
Practice Address - Phone:402-559-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025288900Medicaid
NE2761Medicaid