Provider Demographics
NPI:1780917559
Name:LYTLE, JOHN SLOAN (RN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SLOAN
Last Name:LYTLE
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 1:6300 SHADY GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8832
Mailing Address - Country:US
Mailing Address - Phone:919-237-1471
Mailing Address - Fax:
Practice Address - Street 1:6300 SHADY GLEN TRL
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8832
Practice Address - Country:US
Practice Address - Phone:919-237-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113774163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology