Provider Demographics
NPI:1588362370
Name:SMALLWOOD, ANDREA NICOLE (LSP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 W CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-2293
Mailing Address - Country:US
Mailing Address - Phone:918-639-7970
Mailing Address - Fax:
Practice Address - Street 1:1279 W CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-2293
Practice Address - Country:US
Practice Address - Phone:918-639-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula