=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407750177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERITA RENEA LITTLE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14817 FOOTHILL BLVD APT 2433
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-0718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-835-4213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14817 FOOTHILL BLVD APT 2433
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-0718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-835-4213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN95191936
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------