Individual
MR. SHAWN JERMAINE SMALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(302) 998-0469
Mailing address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 888-0588
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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