Provider Demographics
NPI:1134513575
Name:LITTLE, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BARNACLE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7732
Mailing Address - Country:US
Mailing Address - Phone:907-335-3400
Mailing Address - Fax:907-335-3405
Practice Address - Street 1:630 BARNACLE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7732
Practice Address - Country:US
Practice Address - Phone:907-335-3400
Practice Address - Fax:907-335-3405
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse