MEDICARE: MR. NICHOLAS JOSEPH LITTLE MS

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
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1780249508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS JOSEPH LITTLE MS

Provider Business Mailing Address
First Line	:	10494 MONTGOMERY RD RM 2102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5214
Country	:	US
Telephone Number	:	513-853-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	10494 MONTGOMERY RD RM 2102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5214
Country	:	US
Telephone Number	:	513-853-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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