1265921589 NPI number — ERIN SHARPE SPANGLER FAMILY NURSE PRACTIT

Table of content: ERIN SHARPE SPANGLER FAMILY NURSE PRACTIT (NPI 1265921589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265921589 NPI number — ERIN SHARPE SPANGLER FAMILY NURSE PRACTIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPANGLER
Provider First Name:
ERIN
Provider Middle Name:
SHARPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FAMILY NURSE PRACTIT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPANGLER
Provider Other First Name:
ERIN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265921589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12070 WHITE OAK PLAINS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70714-6207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-610-2122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 PARK ROWE AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-769-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP09883 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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