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NPI Code Detail

MEDICARE: ETHAN LITTLE

MEDICARE: ETHAN LITTLE
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1578316923
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN LITTLE
Provider Business Mailing Address
First Line : 8050 BECKETT CENTER DR STE 302
Second Line :
City : WEST CHESTER
State : OH
Zip : 45069-5033
Country : US
Telephone Number : 513-737-1782
Fax Number :
Provider Business Practice Location Address
First Line : 8050 BECKETT CENTER DR STE 302
Second Line :
City : WEST CHESTER
State : OH
Zip : 45069-5033
Country : US
Telephone Number : 513-737-1782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2024
Last Update Date : 04/08/2024

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Directions to “ ETHAN LITTLE ” Practice Location

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