Provider Demographics
NPI:1487964458
Name:LITTLE OWL, LAVONNE J (RN)
Entity type:Individual
Prefix:
First Name:LAVONNE
Middle Name:J
Last Name:LITTLE OWL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAVONNE
Other - Middle Name:J
Other - Last Name:SCALPCANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10110 SOUTH 7650 EAST
Mailing Address - Street 2:CROW/NORTHERN CHEYENNE HOSPITAL
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022
Mailing Address - Country:US
Mailing Address - Phone:406-477-4477
Mailing Address - Fax:
Practice Address - Street 1:100 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse