Provider Demographics
NPI:1750134052
Name:BARNETTE-SPURLIN, IDA ELIZABETH (CARE COORDINATOR)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:ELIZABETH
Last Name:BARNETTE-SPURLIN
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S RANCHO DR STE 4-337
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-440-8440
Mailing Address - Fax:
Practice Address - Street 1:7291 W CHARLESTON BLVD STE AB&120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1595
Practice Address - Country:US
Practice Address - Phone:725-237-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator