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General NPI Number Information
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NPI Number | 1922378413
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Entity Type | Organization
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Legal Business Name | JEANETTE A. LITTLE LLC
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 268 COUNTY ROAD 123
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City | CHESAPEAKE
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State | OH
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Zip | 45619-7097
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Country | US
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Telephone | 304-544-4237
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Fax | 640-867-4236
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Provider Business Mailing Address
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Address Line | 268 COUNTY ROAD 123
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City | CHESAPEAKE
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State | OH
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Zip | 45619-7097
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Country | US
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Telephone | 304-544-4237
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Fax | 640-867-4236
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Authorized Official
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Title or Position | NURSE
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Name | JEANETTE A LITTLE
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Credential | RN
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Telephone | 304-544-4237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 50649
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License Number State | WV
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