Provider Demographics
NPI:1154679892
Name:SPEARE, DUETTE M (LPN)
Entity Type:Individual
Prefix:
First Name:DUETTE
Middle Name:M
Last Name:SPEARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARVER LOOP
Mailing Address - Street 2:APT 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2922
Mailing Address - Country:US
Mailing Address - Phone:917-862-5212
Mailing Address - Fax:718-347-4643
Practice Address - Street 1:100 CARVER LOOP
Practice Address - Street 2:APT 2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2922
Practice Address - Country:US
Practice Address - Phone:917-862-5212
Practice Address - Fax:718-347-4643
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY268348164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse