Provider Demographics
NPI:1538054481
Name:SMALL, DEBRA DIANE (DNP FNP-C FNP-BC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANE
Last Name:SMALL
Suffix:
Gender:F
Credentials:DNP FNP-C FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12113 DOVE CIR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3131
Mailing Address - Country:US
Mailing Address - Phone:240-354-7455
Mailing Address - Fax:
Practice Address - Street 1:12113 DOVE CIR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3131
Practice Address - Country:US
Practice Address - Phone:240-354-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine