Healthcare Provider Details

I. General information

NPI: 1871858464
Provider Name (Legal Business Name): CELICIA WILLIAMS LITTLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 WOODYARD RD STE 111
CLINTON MD
20735-4226
US

IV. Provider business mailing address

PO BOX 744787
ATLANTA GA
30374-4787
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-0900
  • Fax: 301-599-7828
Mailing address:
  • Phone: 301-572-8734
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR216132
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9267954
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR216132
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: