Healthcare Provider Details

I. General information

NPI: 1659528354
Provider Name (Legal Business Name): ELAINE LITTLE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEDICINE HORSE DR
TOHAJIILEE NM
87026-5145
US

IV. Provider business mailing address

129 MEDICINE HORSE DR
TOHAJIILEE NM
87026-5145
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-2307
  • Fax:
Mailing address:
  • Phone: 505-908-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number806211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: