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NPI Code Detail

MEDICARE: STEPHANIE SMALL NP

MEDICARE: STEPHANIE SMALL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner1010029268VT

General Provider Information

NPI Number : 1538114947
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE SMALL NP
Provider Business Mailing Address
First Line : 429 SPRING ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-3232
Country : US
Telephone Number : 617-413-1293
Fax Number :
Provider Business Practice Location Address
First Line : 3100 PROFESSIONAL DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-5131
Country : US
Telephone Number : 734-973-0710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 07/31/2008

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