Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024174952 | VA |
NPI | 1003346412 |
---|---|
Provider Name | Gwendolyn Williams Spangler |
First Address | Salem, VA 24153-2875 |
Second Address | Blacksburg, VA 24060-6325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |