Healthcare Provider Details

I. General information

NPI: 1649981242
Provider Name (Legal Business Name): JEFFREY ALAN SMALL LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

IV. Provider business mailing address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax: 216-229-2570
Mailing address:
  • Phone: 330-740-9200
  • Fax: 216-229-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.109181.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: