Provider Demographics
NPI:1467606228
Name:LITTLE, MARILYN LOUISE (APRN, PP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LOUISE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:APRN, PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 W 7200 S
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3749
Mailing Address - Country:US
Mailing Address - Phone:801-566-4423
Mailing Address - Fax:
Practice Address - Street 1:198 W 7200 S
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3749
Practice Address - Country:US
Practice Address - Phone:801-566-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT21382844405364SP0809X
UT2138288900364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000065540Medicare PIN
UTU000075213Medicare PIN
UTU000072218Medicare PIN
UTU000075050Medicare PIN