Provider Demographics
NPI:1083386957
Name:SMALL, BRENDA JONES
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JONES
Last Name:SMALL
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 1:610 HEAVEN ST
Mailing Address - Street 2:
Mailing Address - City:NORLINA
Mailing Address - State:NC
Mailing Address - Zip Code:27563-9505
Mailing Address - Country:US
Mailing Address - Phone:252-767-6702
Mailing Address - Fax:
Practice Address - Street 1:610 HEAVEN ST
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9505
Practice Address - Country:US
Practice Address - Phone:252-767-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility