Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00071800 | NJ |
NPI | 1013928746 |
---|---|
Provider Name | Ms. Diana L. Spangenberg |
First Address | Roseland, NJ 07068-1728 |
Second Address | Roseland, NJ 07068-1728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 10/07/2007 |