Provider Demographics
NPI:1164823266
Name:SPEER, KATIE (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SPEER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3158
Mailing Address - Country:US
Mailing Address - Phone:310-559-5916
Mailing Address - Fax:310-559-5466
Practice Address - Street 1:3000 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3158
Practice Address - Country:US
Practice Address - Phone:310-559-5916
Practice Address - Fax:310-559-5466
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21793363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology