Healthcare Provider Details

I. General information

NPI: 1255504262
Provider Name (Legal Business Name): DEBORAH A SPOERNER MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 NORTH ST
LAFAYETTE IN
47901-1152
US

IV. Provider business mailing address

6208 HIGHLAND LN
MC CORDSVILLE IN
46055-9529
US

V. Phone/Fax

Practice location:
  • Phone: 765-742-8589
  • Fax:
Mailing address:
  • Phone: 317-335-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002194A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: