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NPI Code Detail

MEDICARE: MRS. ADRIENNE YOLANDA SMALL FNP

MEDICARE: MRS. ADRIENNE YOLANDA SMALL FNP
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
1363LF0000XFamily Nurse Practitioner200950NC

General Provider Information

NPI Number : 1083695118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADRIENNE YOLANDA SMALL FNP
Provider Business Mailing Address
First Line : 5 BLUEBIRD CT
Second Line :
City : DURHAM
State : NC
Zip : 27713-8139
Country : US
Telephone Number : 919-403-8816
Fax Number :
Provider Business Practice Location Address
First Line : 4104 SURLES CT
Second Line : SUITE 11
City : DURHAM
State : NC
Zip : 27703-8056
Country : US
Telephone Number : 919-941-1911
Fax Number : 919-941-1901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 09/29/2010

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