Provider Demographics
NPI:1093519209
Name:LITTLE, NATALIE KAY
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:KAY
Last Name:LITTLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S HAMLIN LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4123
Mailing Address - Country:US
Mailing Address - Phone:208-559-1390
Mailing Address - Fax:
Practice Address - Street 1:577 E STATE ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5938
Practice Address - Country:US
Practice Address - Phone:208-939-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program