Provider Demographics
NPI:1568596013
Name:LYTTLE, ROSEANN JUNE (RN)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:JUNE
Last Name:LYTTLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-8439
Mailing Address - Country:US
Mailing Address - Phone:520-876-0389
Mailing Address - Fax:
Practice Address - Street 1:1000 N AMARILLO ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-3656
Practice Address - Country:US
Practice Address - Phone:520-836-6694
Practice Address - Fax:520-421-0423
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN124868251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)