Provider Demographics
NPI:1548841497
Name:LITTLE, LAVOYA Y (STNA)
Entity type:Individual
Prefix:MISS
First Name:LAVOYA
Middle Name:Y
Last Name:LITTLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S MCDONEL ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4725
Mailing Address - Country:US
Mailing Address - Phone:567-289-5856
Mailing Address - Fax:
Practice Address - Street 1:413 S MCDONEL ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4725
Practice Address - Country:US
Practice Address - Phone:567-289-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602280981120374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide