MEDICARE: JOETTA LITTLE

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	163WD1100X	Peritoneal Dialysis Registered Nurse	041347586	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.032795	IL

General Provider Information

NPI Number	:	1801605514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOETTA LITTLE

Provider Business Mailing Address
First Line	:	2111 S WABASH AVE APT 2209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1794
Country	:	US
Telephone Number	:	217-552-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 S KOSTNER AVE STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1120
Country	:	US
Telephone Number	:	217-284-2608
Fax Number	:	217-439-3547

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	12/09/2025

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Directions to “ JOETTA LITTLE ” Practice Location

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