Provider Demographics
NPI:1336322163
Name:SMALL, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
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 1:23 DAFFODIL LN
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6014
Mailing Address - Country:US
Mailing Address - Phone:508-825-2250
Mailing Address - Fax:
Practice Address - Street 1:23 DAFFODIL LN
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-6014
Practice Address - Country:US
Practice Address - Phone:508-825-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-15
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242317163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse