Provider Demographics
NPI:1487010484
Name:SPANN, ROSE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
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 1:1425 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31415-7891
Mailing Address - Country:US
Mailing Address - Phone:912-220-4161
Mailing Address - Fax:
Practice Address - Street 1:835 E 65TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4430
Practice Address - Country:US
Practice Address - Phone:912-355-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN079801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist