Healthcare Provider Details

I. General information

NPI: 1568789162
Provider Name (Legal Business Name): MS. EDWINA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MR. OMARR Q LITTLE

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MAIN ST.
MT.GILEAD NC
27306
US

IV. Provider business mailing address

P O BOX 1432
MT.GILEAD NC
27306
US

V. Phone/Fax

Practice location:
  • Phone: 910-573-0492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: