Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R150276 | MD |
NPI | 1073519963 |
---|---|
Provider Name | Mary Spangler |
First Address | Chesapeake Beach, MD 20732-4116 |
Second Address | Elkridge, MD 21075-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 28/04/2014 |