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General NPI Number Information
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NPI Number | 1750182903
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Entity Type | Individual
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Provider Name | JESSICA ANN SMALLPAGE
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 11407 W OKLAHOMA AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-3940
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Country | US
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Telephone | 715-321-1765
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Fax |
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Provider Business Mailing Address
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Address Line | 11407 W OKLAHOMA AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-3940
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Country | US
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Telephone | 715-321-1765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 249369-30
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License Number State | WI
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