Healthcare Provider Details

I. General information

NPI: 1669987392
Provider Name (Legal Business Name): KATHERINE ROSE LITTLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

1605 CHRISTIAN ST UNIT 1
PHILADELPHIA PA
19146-2009
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-3000
  • Fax:
Mailing address:
  • Phone: 508-769-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number26NJ00786100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: