Provider Demographics
NPI:1679685374
Name:LITTLE, NANCY A (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:830 S HAM LN
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7510
Mailing Address - Country:US
Mailing Address - Phone:209-368-6661
Mailing Address - Fax:209-333-7655
Practice Address - Street 1:830 S HAM LN
Practice Address - Street 2:SUITE 26
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7510
Practice Address - Country:US
Practice Address - Phone:209-368-6661
Practice Address - Fax:209-333-7655
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65454208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65454OtherLICENSE
CA010739OtherHILL PHYSICIANS
CA340014391OtherRAILROAD MEDICARE
CA340014391OtherRAILROAD MEDICARE
CA942415776OtherEIN