Provider Demographics
NPI:1396369401
Name:SPANO, EMILY A (DNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:SPANO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:EMELIA
Other - Middle Name:
Other - Last Name:PERSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0964
Mailing Address - Country:US
Mailing Address - Phone:480-366-4489
Mailing Address - Fax:602-635-3683
Practice Address - Street 1:81 W GUADALUPE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-366-4489
Practice Address - Fax:602-635-3683
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241577363L00000X
AZ242577363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner