Provider Demographics
NPI:1699485326
Name:LITTLE, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
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 1:45 WINDEMERE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2226
Mailing Address - Country:US
Mailing Address - Phone:413-335-2704
Mailing Address - Fax:413-301-5633
Practice Address - Street 1:45 WINDEMERE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2226
Practice Address - Country:US
Practice Address - Phone:413-335-2704
Practice Address - Fax:413-301-5633
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN253081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse