Provider Demographics
NPI:1477546463
Name:SPRUCE, HARUHAUANI (MD)
Entity Type:Individual
Prefix:
First Name:HARUHAUANI
Middle Name:
Last Name:SPRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S FOCH ST
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-3331
Mailing Address - Country:US
Mailing Address - Phone:575-894-4000
Mailing Address - Fax:404-601-2761
Practice Address - Street 1:455 S FOCH ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-3331
Practice Address - Country:US
Practice Address - Phone:575-894-4000
Practice Address - Fax:404-601-2761
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87230275Medicaid
H94779Medicare UPIN
NM341421703Medicare ID - Type Unspecified