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Individual
MR. SHAWN JERMAINE SMALLS
Active
Individual
MR. SHAWN JERMAINE SMALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L2-0010853
DE
164W00000X
Licensed Practical Nurse
PN278828
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164W00000X
INDIVIDUAL PROVIDER
DE
01
—
164W00000X
INDIVIDUAL PROVIDER
MD
01
—
164W00000X
INDIVIDUAL PROVIDER
PA
Enumeration date
06/07/2012
Last updated
11/01/2013
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