Provider Demographics
NPI:1568789162
Name:LITTLE, EDWINA
Entity Type:Individual
Prefix:MS
First Name:EDWINA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:OMARR
Other - Middle Name:Q
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 1432
Mailing Address - Street 2:
Mailing Address - City:MT.GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:MT.GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306
Practice Address - Country:US
Practice Address - Phone:910-573-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide