Provider Demographics
NPI:1205320322
Name:LITTLEJOHN, RICHELLE MARVETT (LVN)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:MARVETT
Last Name:LITTLEJOHN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 W 139TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2235
Mailing Address - Country:US
Mailing Address - Phone:310-353-6489
Mailing Address - Fax:
Practice Address - Street 1:1364 W 139TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-2235
Practice Address - Country:US
Practice Address - Phone:310-353-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693205364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist