Healthcare Provider Details

I. General information

NPI: 1063423747
Provider Name (Legal Business Name): MARCI JANE SPRUILL MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-445-7837
  • Fax: 805-445-7830
Mailing address:
  • Phone: 805-445-7837
  • Fax: 805-445-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: