Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD2020-0980 | NM |
N | 207T00000X | Neurosurgeon | ME 123879 | FL |
NPI | 1003012188 |
---|---|
Provider Name | Heather Stevens Spader |
First Address | Albuquerque, NM 87106-2719 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015345100 | (05) | FL |