Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704261249 | MI |
NPI | 1003572199 |
---|---|
Provider Name | Rebecca Spalo |
First Address | Cedar Springs, MI 49319-8365 |
Second Address | Flint, MI 48502-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2021 |
Last Update Date | 12/11/2021 |