Provider Demographics
NPI:1083695118
Name:SMALL, ADRIENNE YOLANDA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:YOLANDA
Last Name:SMALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:YOLANDA
Other - Last Name:FULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5 BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8139
Mailing Address - Country:US
Mailing Address - Phone:919-403-8816
Mailing Address - Fax:
Practice Address - Street 1:4104 SURLES CT
Practice Address - Street 2:SUITE 11
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8056
Practice Address - Country:US
Practice Address - Phone:919-941-1911
Practice Address - Fax:919-941-1901
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593471CMedicare UPIN