Provider Demographics
NPI:1861762510
Name:LITTLE, JEANETTE A (RN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:A
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 COUNTY ROAD 123
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7097
Mailing Address - Country:US
Mailing Address - Phone:304-544-4237
Mailing Address - Fax:740-867-4236
Practice Address - Street 1:268 COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-7097
Practice Address - Country:US
Practice Address - Phone:304-544-4237
Practice Address - Fax:740-867-4236
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse