Provider Demographics
NPI:1316782857
Name:LITTLE, HALLIE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
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 1:300 E MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1782
Mailing Address - Country:US
Mailing Address - Phone:317-210-3722
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1782
Practice Address - Country:US
Practice Address - Phone:317-210-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86153473OtherCOMMISSION ON DIETETIC REGISTRATION