Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 24377 | IA |
NPI | 1962491373 |
---|---|
Provider Name | Dr. Marta Marie Little |
First Address | Charlotte, NC 28260-3725 |
Second Address | Coralville, IA 52241-1757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 09/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0217711 | (05) | IA |
1217711 | (05) | IA |
46328 | WELLMARK BCBS (01) | IA |
A02480 | (02) |