Provider Demographics
NPI:1649235730
Name:STUART-SMALLEY, DEBRA FRANCES (CNM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:FRANCES
Last Name:STUART-SMALLEY
Suffix:
Gender:F
Credentials:CNM
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 1630
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-1630
Mailing Address - Country:US
Mailing Address - Phone:928-368-0461
Mailing Address - Fax:928-368-4333
Practice Address - Street 1:1757 W JACKSON LN
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-7301
Practice Address - Country:US
Practice Address - Phone:928-368-0461
Practice Address - Fax:928-368-4333
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN066323367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ069113Medicaid
AZ069113Medicaid
AZZNM110Medicare PIN