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NPI Code Detail

MEDICARE: MRS. EARLINE LITTLE NURSE PRACTITIONER

MEDICARE: MRS. EARLINE LITTLE NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner19322SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487073219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EARLINE LITTLE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : PO BOX 1090
Second Line :
City : HARTSVILLE
State : SC
Zip : 29551-1090
Country : US
Telephone Number : 843-857-0111
Fax Number : 843-309-8126
Provider Business Practice Location Address
First Line : 3080 HIGHWAY 15-401 E
Second Line :
City : MC COLL
State : SC
Zip : 29570-6128
Country : US
Telephone Number : 843-523-5751
Fax Number : 843-523-6040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2014
Last Update Date : 08/19/2025

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