Individual
MRS. SHARON DIANE LYTTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1744000000X
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3126907
—
TN
01
—
4102606
BLUE CROSS BLUE SHEILD
TN
Enumeration date
03/26/2007
Last updated
07/08/2007
Update your record
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