Provider Demographics
NPI:1548564750
Name:LITTLE CHEYANNA PLLC
Entity Type:Organization
Organization Name:LITTLE CHEYANNA PLLC
Other - Org Name:JOHN P. ROSENICK FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:919-775-1310
Mailing Address - Street 1:1007 CARTHAGE STREET
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-775-1310
Mailing Address - Fax:
Practice Address - Street 1:1007 CARTHAGE STREET
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-775-1355
Practice Address - Fax:919-775-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107601364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty