Provider Demographics
NPI:1710457601
Name:LITTLETON, MICHAEL JEREMEY (COMMUNITY PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEREMEY
Last Name:LITTLETON
Suffix:
Gender:M
Credentials:COMMUNITY PARAMEDIC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:JEREMEY
Other - Last Name:LITTLETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COMMUNITY PARAMEDIC
Mailing Address - Street 1:111 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2434
Mailing Address - Country:US
Mailing Address - Phone:307-358-1435
Mailing Address - Fax:307-358-7310
Practice Address - Street 1:111 S 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2434
Practice Address - Country:US
Practice Address - Phone:307-358-1435
Practice Address - Fax:307-358-7310
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY108474146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic