Provider Demographics
NPI:1326703158
Name:SPANO, CHRISTEN DEANNE
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:DEANNE
Last Name:SPANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 WASHBOARD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-7560
Mailing Address - Country:US
Mailing Address - Phone:678-982-4174
Mailing Address - Fax:
Practice Address - Street 1:2129 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-2600
Practice Address - Country:US
Practice Address - Phone:770-209-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN150561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner