Provider Demographics
NPI:1982660098
Name:SMALL, DEBORAH K (RN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:K
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 1:11050 FANCHER RD
Mailing Address - Street 2:LOT 281
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9719
Mailing Address - Country:US
Mailing Address - Phone:614-939-0437
Mailing Address - Fax:614-939-0497
Practice Address - Street 1:11050 FANCHER RD
Practice Address - Street 2:LOT 281
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9719
Practice Address - Country:US
Practice Address - Phone:614-939-0437
Practice Address - Fax:614-939-0497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 205154163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258251Medicaid