Provider Demographics
NPI:1598270928
Name:SPANGLER, HOLLIE M
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:M
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10340 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:MI
Mailing Address - Zip Code:49288-9751
Mailing Address - Country:US
Mailing Address - Phone:419-212-4468
Mailing Address - Fax:
Practice Address - Street 1:511 PERRY ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2123
Practice Address - Country:US
Practice Address - Phone:419-237-3103
Practice Address - Fax:419-237-4044
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.163367OtherLICENSE