Healthcare Provider Details

I. General information

NPI: 1912241514
Provider Name (Legal Business Name): EMILY ANN SPEARS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY ANN ZGORSKI CPNA

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 WATERLOO RD SUITE 110
COLUMBIA MD
21045-2639
US

IV. Provider business mailing address

5900 WATERLOO RD SUITE 110
COLUMBIA MD
21045-2639
US

V. Phone/Fax

Practice location:
  • Phone: 443-451-1600
  • Fax:
Mailing address:
  • Phone: 443-451-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR200773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: