Provider Demographics
NPI:1508089772
Name:LITTLE, AMY M (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
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 1:36660 HOCKING DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8505
Mailing Address - Country:US
Mailing Address - Phone:740-385-8524
Mailing Address - Fax:
Practice Address - Street 1:36660 HOCKING DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8505
Practice Address - Country:US
Practice Address - Phone:740-385-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-099707164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse