Provider Demographics
NPI:1710447909
Name:LITTLE, MINA O (LPN)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:O
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 BIRKHALL WAY # 2451
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3496
Mailing Address - Country:US
Mailing Address - Phone:770-789-0132
Mailing Address - Fax:
Practice Address - Street 1:2451 BIRKHALL WAY # 2451
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3496
Practice Address - Country:US
Practice Address - Phone:770-789-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN086214164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse