Provider Demographics
NPI:1609298421
Name:SMALLEY, MICHAEL (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0029
Mailing Address - Country:US
Mailing Address - Phone:907-852-9203
Mailing Address - Fax:907-852-6616
Practice Address - Street 1:1296 AGVIK STREET
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723-0029
Practice Address - Country:US
Practice Address - Phone:907-852-9203
Practice Address - Fax:907-852-6616
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6696164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse