Provider Demographics
NPI:1386227908
Name:LITTERAL, ELLIOT BRADLEY (RN)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:BRADLEY
Last Name:LITTERAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 POND BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-8734
Mailing Address - Country:US
Mailing Address - Phone:803-917-2861
Mailing Address - Fax:
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-5698
Practice Address - Fax:843-777-5572
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC230599163WC0200X
SC25041367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine