Provider Demographics
NPI:1760148894
Name:LITTLE, DWANDA M
Entity Type:Individual
Prefix:
First Name:DWANDA
Middle Name:M
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 WALFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-7322
Mailing Address - Country:US
Mailing Address - Phone:195-482-9920
Mailing Address - Fax:
Practice Address - Street 1:4821 WALFORD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-7322
Practice Address - Country:US
Practice Address - Phone:195-482-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health