Healthcare Provider Details

I. General information

NPI: 1750182903
Provider Name (Legal Business Name): JESSICA ANN SMALLPAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11407 W OKLAHOMA AVE
WEST ALLIS WI
53227-3940
US

IV. Provider business mailing address

11407 W OKLAHOMA AVE
WEST ALLIS WI
53227-3940
US

V. Phone/Fax

Practice location:
  • Phone: 715-321-1765
  • Fax:
Mailing address:
  • Phone: 715-321-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number249369-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: