Provider Demographics
NPI:1649520743
Name:LITTLE, WADE EUGENE (RN)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:EUGENE
Last Name:LITTLE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14536 S IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9116
Mailing Address - Country:US
Mailing Address - Phone:503-348-6833
Mailing Address - Fax:
Practice Address - Street 1:14536 S IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9116
Practice Address - Country:US
Practice Address - Phone:503-348-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840597RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse