Provider Demographics
NPI:1972770659
Name:SPURLOCK, CAROLYN B
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 17TH ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2360
Mailing Address - Country:US
Mailing Address - Phone:304-237-1350
Mailing Address - Fax:
Practice Address - Street 1:2183 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2303
Practice Address - Country:US
Practice Address - Phone:718-336-4119
Practice Address - Fax:718-336-4113
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001673-1367A00000X
WV125176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife