Provider Demographics
NPI:1669974721
Name:SMALLWOOD, DANA L (FNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 HOSPITAL DR NW
Mailing Address - Street 2:ER
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1540
Mailing Address - Country:US
Mailing Address - Phone:812-738-7843
Mailing Address - Fax:
Practice Address - Street 1:1141 HOSPITAL DR NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2164
Practice Address - Country:US
Practice Address - Phone:812-738-7843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013392363L00000X
IN28175377A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300030269Medicaid
KY7100628550Medicaid
IN412840119OtherMEDICARE