Provider Demographics
NPI:1619299914
Name:LITTLE, MILDRED LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:LOUISE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MIDGE
Other - Middle Name:LOUISE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:64 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1021
Mailing Address - Country:US
Mailing Address - Phone:614-278-2671
Mailing Address - Fax:
Practice Address - Street 1:64 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1021
Practice Address - Country:US
Practice Address - Phone:614-278-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse