Provider Demographics
NPI:1417333014
Name:SPIVEY, RHONDA SUE (CFM)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-4489
Mailing Address - Fax:
Practice Address - Street 1:95 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFM02938224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417333014Medicaid