Provider Demographics
NPI:1265796304
Name:SMALL, MICHAELA LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:LYNN
Last Name:SMALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:LYNN
Other - Last Name:HAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47452 268TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUMPHREY
Mailing Address - State:NE
Mailing Address - Zip Code:68642
Mailing Address - Country:US
Mailing Address - Phone:402-923-0150
Mailing Address - Fax:402-844-8356
Practice Address - Street 1:47452 268TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HUMPHREY
Practice Address - State:NE
Practice Address - Zip Code:68642
Practice Address - Country:US
Practice Address - Phone:402-923-0150
Practice Address - Fax:402-844-8356
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily