Provider Demographics
NPI:1588494264
Name:LITTLE, YUVODKA SHARICE (PARAMEDICAL ARTIST)
Entity type:Individual
Prefix:
First Name:YUVODKA
Middle Name:SHARICE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PARAMEDICAL ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 153RD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1104
Mailing Address - Country:US
Mailing Address - Phone:708-770-3555
Mailing Address - Fax:800-918-3011
Practice Address - Street 1:4821 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3955
Practice Address - Country:US
Practice Address - Phone:800-780-2959
Practice Address - Fax:800-918-3011
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL230343305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service