Provider Demographics
NPI:1427591791
Name:SPANN, CATHERINE NAOMI (LPN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:NAOMI
Last Name:SPANN
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 1:150 SCANTRON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICH
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-651-2253
Mailing Address - Fax:912-651-2365
Practice Address - Street 1:107 B FAHM STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAG
Practice Address - State:GA
Practice Address - Zip Code:31401
Practice Address - Country:US
Practice Address - Phone:912-651-2253
Practice Address - Fax:912-651-2365
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN092483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse