Provider Demographics
NPI:1922378413
Name:JEANETTE A. LITTLE LLC
Entity Type:Organization
Organization Name:JEANETTE A. LITTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-544-4237
Mailing Address - Street 1:268 COUNTY ROAD 123
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7097
Mailing Address - Country:US
Mailing Address - Phone:304-544-4237
Mailing Address - Fax:640-867-4236
Practice Address - Street 1:268 COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-7097
Practice Address - Country:US
Practice Address - Phone:304-544-4237
Practice Address - Fax:640-867-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50649252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency