MEDICARE: PRETTY LITTLE NURSE LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1932943081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRETTY LITTLE NURSE LLC

Provider Business Mailing Address
First Line	:	5105A SUMMER GARDEN PL
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 GITTINGS ST STE 100B
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6155
Country	:	US
Telephone Number	:	757-895-1449
Fax Number	:	757-782-8100

Authorized Official
Title or Position	:	OWNER
Name	:	CHANEL CARRINGTON
Credential	:
Telephone Number	:	757-339-4543

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	09/30/2024

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