Provider Demographics
NPI:1326678319
Name:LITTLE, DESIREE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E THOMAS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7767
Mailing Address - Country:US
Mailing Address - Phone:602-266-2200
Mailing Address - Fax:602-604-5046
Practice Address - Street 1:1910 E THOMAS RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7767
Practice Address - Country:US
Practice Address - Phone:602-266-2200
Practice Address - Fax:602-604-5046
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ237707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily