MEDICARE: MRS. CHRISTI GRACE LITTLEFIELD LPN

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
1	164W00000X	Licensed Practical Nurse	110730-1	NY

General Provider Information

NPI Number	:	1730410994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTI GRACE LITTLEFIELD LPN

Provider Business Mailing Address
First Line	:	213 MAIN ST
Second Line	:
City	:	PORT BYRON
State	:	NY
Zip	:	13140-3304
Country	:	US
Telephone Number	:	315-776-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 MAIN ST
Second Line	:
City	:	PORT BYRON
State	:	NY
Zip	:	13140-3304
Country	:	US
Telephone Number	:	315-776-4938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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