Provider Demographics
NPI:1467280016
Name:WILLIE, LINDA LITTOPO
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LITTOPO
Last Name:WILLIE
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 1:202 SAN JUAN DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1014
Mailing Address - Country:US
Mailing Address - Phone:651-263-2849
Mailing Address - Fax:
Practice Address - Street 1:202 SAN JUAN DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1014
Practice Address - Country:US
Practice Address - Phone:651-263-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND39680253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care