Provider Demographics
NPI:1114168168
Name:LITTLE, LONDA LANEE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:LONDA
Middle Name:LANEE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 160TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8514
Mailing Address - Country:US
Mailing Address - Phone:253-414-8780
Mailing Address - Fax:
Practice Address - Street 1:413 160TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8514
Practice Address - Country:US
Practice Address - Phone:253-414-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60059390172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker