Healthcare Provider Details

I. General information

NPI: 1346085313
Provider Name (Legal Business Name): HANNAH SARAH LYTTLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W SAINT JOHN ST
TARBORO NC
27886-4316
US

IV. Provider business mailing address

4204 SIX FORKS RD APT 3211
RALEIGH NC
27609-6452
US

V. Phone/Fax

Practice location:
  • Phone: 252-823-4300
  • Fax:
Mailing address:
  • Phone: 804-432-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: