Healthcare Provider Details

I. General information

NPI: 1568183895
Provider Name (Legal Business Name): MARTA MARIEL LITTLE APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S STE 700
MINNEAPOLIS MN
55454-1462
US

IV. Provider business mailing address

2318 MILWAUKEE AVE
MINNEAPOLIS MN
55404-3150
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7111
  • Fax:
Mailing address:
  • Phone: 612-810-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number512
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: