Provider Demographics
NPI:1487023644
Name:BRACKETT-LITTLE, CLAUDETTE PATRICIA
Entity Type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:PATRICIA
Last Name:BRACKETT-LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 VILLAGE DR APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-8260
Mailing Address - Country:US
Mailing Address - Phone:631-782-5037
Mailing Address - Fax:
Practice Address - Street 1:604 VILLAGE DR APT A
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-8260
Practice Address - Country:US
Practice Address - Phone:631-782-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse