Provider Demographics
NPI:1881678803
Name:SPACH, BRENDA LEE (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:SPACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MAY FARM RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5749
Mailing Address - Country:US
Mailing Address - Phone:919-533-6020
Mailing Address - Fax:919-533-6020
Practice Address - Street 1:301 LLOYD STREET
Practice Address - Street 2:PIEDMONT HEALTH SERVICES, INC.
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1821
Practice Address - Country:US
Practice Address - Phone:919-942-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN909363LF0000X
NC0050-01741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily