Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 9177730 | FL |
NPI | 1013181213 |
---|---|
Provider Name | Ms. Beverley W. Spalding |
First Address | Palm Bay, FL 32911-0637 |
Second Address | Palm Bay, FL 32908-7518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |