Provider Demographics
NPI:1720704927
Name:LITTLE, DEBRA JO
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JO
Last Name:LITTLE
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 1:1527 WAKE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1235
Mailing Address - Country:US
Mailing Address - Phone:937-231-1771
Mailing Address - Fax:
Practice Address - Street 1:217 S DELMAR AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2817
Practice Address - Country:US
Practice Address - Phone:937-999-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant