Provider Demographics
NPI:1699540831
Name:LITTLESHIELD, TEELYNN (CNA)
Entity type:Individual
Prefix:
First Name:TEELYNN
Middle Name:
Last Name:LITTLESHIELD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0250
Mailing Address - Country:US
Mailing Address - Phone:406-679-5585
Mailing Address - Fax:
Practice Address - Street 1:15230 US HWY 287
Practice Address - Street 2:
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514-0250
Practice Address - Country:US
Practice Address - Phone:406-679-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52921376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide