Provider Demographics
NPI:1700776283
Name:SMALL-WASHINGTON, CHEVONNE (LPN)
Entity type:Individual
Prefix:
First Name:CHEVONNE
Middle Name:
Last Name:SMALL-WASHINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHEVONNE
Other - Middle Name:
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:71 BLAUVELT RD
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1228
Mailing Address - Country:US
Mailing Address - Phone:914-230-2151
Mailing Address - Fax:
Practice Address - Street 1:71 BLAUVELT RD
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1228
Practice Address - Country:US
Practice Address - Phone:914-230-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273543164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse