Provider Demographics
NPI:1487657110
Name:SPANBAUER, SHARON KAY (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:SPANBAUER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1257 E SIENA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1755
Mailing Address - Country:US
Mailing Address - Phone:517-264-7190
Mailing Address - Fax:517-264-7756
Practice Address - Street 1:1247 E SIENA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-264-7190
Practice Address - Fax:517-264-7756
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008767670OtherBLUE CROSS/BLUE SHLD PIN
MI0N43710Medicare PIN
MIP50411Medicare UPIN