Healthcare Provider Details

I. General information

NPI: 1528256344
Provider Name (Legal Business Name): JENNY LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TRILLIUM RDG
BOONE NC
28607-7981
US

IV. Provider business mailing address

304 TRILLIUM RDG
BOONE NC
28607-7981
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number6985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: