Provider Demographics
NPI:1407468176
Name:SMALL, PAGEEN MANOLIS (RN)
Entity Type:Individual
Prefix:
First Name:PAGEEN
Middle Name:MANOLIS
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 1:141 SHATO LN
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4201
Mailing Address - Country:US
Mailing Address - Phone:608-443-7760
Mailing Address - Fax:
Practice Address - Street 1:141 SHATO LN
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4201
Practice Address - Country:US
Practice Address - Phone:608-443-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162792163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health