Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | RN248614 | GA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN248614 | GA |
NPI | 1265918015 |
---|---|
Provider Name | Brittany Lynn Greenspan |
First Address | Gainesville, GA 30503-0658 |
Second Address | Gainesville, GA 30501-3899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 10/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003212335A | (05) | GA |
003212335B | (05) | GA |
06390600 | AMERIGROUP (01) | GA |
1751922 | WELLCARE (01) | GA |