Provider Demographics
NPI:1629289095
Name:LITTLE, JESSICA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SCOTT DYER RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2307
Mailing Address - Country:US
Mailing Address - Phone:207-272-8147
Mailing Address - Fax:
Practice Address - Street 1:3 DURHAM ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1970
Practice Address - Country:US
Practice Address - Phone:207-272-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered