Provider Demographics
NPI:1295438570
Name:LITTLE DOG, NOBLEE (HEALTH TECHNICIAN)
Entity type:Individual
Prefix:
First Name:NOBLEE
Middle Name:
Last Name:LITTLE DOG
Suffix:
Gender:F
Credentials:HEALTH TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 7TH ST NE TRLR 125
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1155
Mailing Address - Country:US
Mailing Address - Phone:406-564-9313
Mailing Address - Fax:
Practice Address - Street 1:425 SMELTER AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1927
Practice Address - Country:US
Practice Address - Phone:406-247-7130
Practice Address - Fax:406-247-7232
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT366321376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide