Provider Demographics
NPI:1336599166
Name:SPITLER, VAN
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:SPITLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 DELISLE FOURMAN RD
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-9641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9930 DELISLE FOURMAN RD
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-9641
Practice Address - Country:US
Practice Address - Phone:937-418-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.406447-163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health