Provider Demographics
NPI:1356973150
Name:SMALL, MARLA JO (RN, MSN)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JO
Last Name:SMALL
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1048
Mailing Address - Country:US
Mailing Address - Phone:812-885-8010
Mailing Address - Fax:812-885-8754
Practice Address - Street 1:615 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1048
Practice Address - Country:US
Practice Address - Phone:812-885-8010
Practice Address - Fax:812-885-8754
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28100603A163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty