Healthcare Provider Details

I. General information

NPI: 1740471978
Provider Name (Legal Business Name): MRS. MICHELE L LITTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC 0946
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 W ARBOR DR MC 0946
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-4332
  • Fax: 858-822-4438
Mailing address:
  • Phone: 858-822-4332
  • Fax: 858-822-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 13577
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN356949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: