MEDICARE: DWANDA M 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1760148894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWANDA M LITTLE

Provider Business Mailing Address
First Line	:	4821 WALFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-7322
Country	:	US
Telephone Number	:	195-482-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 WALFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-7322
Country	:	US
Telephone Number	:	195-482-9920
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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Directions to “ DWANDA M LITTLE ” Practice Location

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