Provider Demographics
NPI:1073955449
Name:SMALL, ANITA RAE (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:RAE
Last Name:SMALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:BUSBY
Mailing Address - State:MT
Mailing Address - Zip Code:59016-0203
Mailing Address - Country:US
Mailing Address - Phone:406-477-4400
Mailing Address - Fax:406-477-8204
Practice Address - Street 1:100 CHEYENNE AVENUE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4400
Practice Address - Fax:406-477-8204
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN25765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse