Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 104387155 | NC |
NPI | 1235638305 |
---|---|
Provider Name | Mrs. Megann Colwell Spore |
First Address | Durham, NC 27713-8134 |
Second Address | Jacksonville, FL 32207-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |