Healthcare Provider Details

I. General information

NPI: 1801605514
Provider Name (Legal Business Name): JOETTA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 S KOSTNER AVE STE 400
CHICAGO IL
60652-1120
US

IV. Provider business mailing address

2111 S WABASH AVE APT 2209
CHICAGO IL
60616-1794
US

V. Phone/Fax

Practice location:
  • Phone: 217-284-2608
  • Fax: 217-439-3547
Mailing address:
  • Phone: 217-552-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number041347586
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: