Healthcare Provider Details

I. General information

NPI: 1548853948
Provider Name (Legal Business Name): ALLENE NIKKI LITTLEWIND CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BELLILE ST
SAINT MICHAEL ND
58370-7010
US

IV. Provider business mailing address

PO BOX 564
FORT TOTTEN ND
58335-0564
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-4442
  • Fax:
Mailing address:
  • Phone: 701-230-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number75078
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: