Provider Demographics
NPI:1619747235
Name:LITTLE, JOELENE (RN BSN)
Entity Type:Individual
Prefix:
First Name:JOELENE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-020
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5381
Mailing Address - Country:US
Mailing Address - Phone:269-341-7493
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-020
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5381
Practice Address - Country:US
Practice Address - Phone:269-341-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308555163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice