Healthcare Provider Details

I. General information

NPI: 1124697115
Provider Name (Legal Business Name): RACHEL LITTLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 HANLEY INDUSTRIAL CT
SAINT LOUIS MO
63144-1910
US

IV. Provider business mailing address

1801 HIGHWAY P
O FALLON MO
63366-4608
US

V. Phone/Fax

Practice location:
  • Phone: 314-262-8259
  • Fax:
Mailing address:
  • Phone: 314-779-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberTEM-COV19-10106
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number146910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: