Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP5326 | AZ |
NPI | 1013316025 |
---|---|
Provider Name | Jenny Littrell |
First Address | Chandler, AZ 85246-6423 |
Second Address | Gilbert, AZ 85297-7341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2014 |
Last Update Date | 10/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
936856 | AHCCCS (01) | AZ |