Provider Demographics
NPI:1043689490
Name:NEDOSPASOVA, MARINA VICTOROVNA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:VICTOROVNA
Last Name:NEDOSPASOVA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:WINN ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:1061 HARMON AVE
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-5687
Mailing Address - Fax:
Practice Address - Street 1:WINN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:1061 HARMON AVE
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-138584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP8698OtherLICENSE