Provider Demographics
NPI:1407639453
Name:LITTLE, TAMMISHIA (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMISHIA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1048
Mailing Address - Country:US
Mailing Address - Phone:773-960-1202
Mailing Address - Fax:708-933-3459
Practice Address - Street 1:7716 S CREGIER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-4610
Practice Address - Country:US
Practice Address - Phone:773-960-1202
Practice Address - Fax:708-933-3459
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043125920164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273988661001Medicaid