Provider Demographics
NPI:1609680974
Name:SMITH, TRIVINES TYLEE
Entity type:Individual
Prefix:
First Name:TRIVINES
Middle Name:TYLEE
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 1:3216 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-4264
Mailing Address - Country:US
Mailing Address - Phone:402-238-9575
Mailing Address - Fax:
Practice Address - Street 1:3216 SEWARD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-4264
Practice Address - Country:US
Practice Address - Phone:402-238-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376G00000X, 374U00000X
NE376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker