Provider Demographics
NPI:1629969167
Name:SMITH, CORTAIJAH CORIENNA
Entity type:Individual
Prefix:
First Name:CORTAIJAH
Middle Name:CORIENNA
Last Name:SMITH
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 1:5319 N 30TH ST APT 505
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1658
Mailing Address - Country:US
Mailing Address - Phone:531-777-4980
Mailing Address - Fax:
Practice Address - Street 1:9910 N 48TH ST STE 111D
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1548
Practice Address - Country:US
Practice Address - Phone:531-777-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-12
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant