Provider Demographics
NPI:1740685882
Name:SMALL, FARRALYNN (LPN)
Entity type:Individual
Prefix:
First Name:FARRALYNN
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17953 LAKE SHORE BLVD
Mailing Address - Street 2:APT 3
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1272
Mailing Address - Country:US
Mailing Address - Phone:216-375-2048
Mailing Address - Fax:
Practice Address - Street 1:17953 LAKE SHORE BLVD
Practice Address - Street 2:APT 3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1272
Practice Address - Country:US
Practice Address - Phone:216-375-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN153030164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse