Healthcare Provider Details

I. General information

NPI: 1245171297
Provider Name (Legal Business Name): MS. CHERRY LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20280 GOVERNORS DR. SUITE 202
MATTESON IL
60443
US

IV. Provider business mailing address

7230 171 ST PO BOX 224
TINLEY PARK IL
60477
US

V. Phone/Fax

Practice location:
  • Phone: 773-470-3303
  • Fax:
Mailing address:
  • Phone: 773-470-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043121096
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: