Provider Demographics
NPI:1982296323
Name:SPEARS, ELIZA ROSE (CPM, LM, LDEM)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:ROSE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:CPM, LM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 N STONE MOUNTAIN DR UNIT 58
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7609
Mailing Address - Country:US
Mailing Address - Phone:801-702-2069
Mailing Address - Fax:
Practice Address - Street 1:438 N STONE MOUNTAIN DR UNIT 58
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7609
Practice Address - Country:US
Practice Address - Phone:801-702-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11376936-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife