Healthcare Provider Details

I. General information

NPI: 1407750177
Provider Name (Legal Business Name): SHERITA RENEA LITTLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14817 FOOTHILL BLVD APT 2433
FONTANA CA
92335-0718
US

IV. Provider business mailing address

14817 FOOTHILL BLVD APT 2433
FONTANA CA
92335-0718
US

V. Phone/Fax

Practice location:
  • Phone: 760-835-4213
  • Fax:
Mailing address:
  • Phone: 760-835-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95191936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: