Provider Demographics
NPI:1326679945
Name:LITTLE, RESHADA SINGLETON (PHLEBOTOMIST)
Entity Type:Individual
Prefix:MRS
First Name:RESHADA
Middle Name:SINGLETON
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:RESHADA
Other - Middle Name:SINGLETON
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHLEBOTOMIST
Mailing Address - Street 1:2500 OLD TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2779
Mailing Address - Country:US
Mailing Address - Phone:225-301-5227
Mailing Address - Fax:
Practice Address - Street 1:2500 OLD TOWNE DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2779
Practice Address - Country:US
Practice Address - Phone:225-301-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000OtherPRIVATE PAYMENT