Provider Demographics
NPI:1528009263
Name:SPAINHOUR, MARY V (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:V
Last Name:SPAINHOUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61319
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-1319
Mailing Address - Country:US
Mailing Address - Phone:919-544-6318
Mailing Address - Fax:919-544-6336
Practice Address - Street 1:515 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4627
Practice Address - Country:US
Practice Address - Phone:336-599-1794
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2807906AMedicare ID - Type UnspecifiedMEDICARE INDIV
NCP84265Medicare UPIN