Provider Demographics
NPI:1588723043
Name:LITTLE, JEAN M (RD, CDN)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 BARNUM RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9744
Mailing Address - Country:US
Mailing Address - Phone:716-352-6577
Mailing Address - Fax:716-407-3103
Practice Address - Street 1:5432 BARNUM RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-9744
Practice Address - Country:US
Practice Address - Phone:716-352-6577
Practice Address - Fax:716-407-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY--2123-1133V00000X
NY002123-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered