Healthcare Provider Details

I. General information

NPI: 1881678803
Provider Name (Legal Business Name): BRENDA LEE SPACH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD STREET PIEDMONT HEALTH SERVICES, INC.
CARRBORO NC
27510-1821
US

IV. Provider business mailing address

425 MAY FARM RD
PITTSBORO NC
27312-5749
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-8741
  • Fax:
Mailing address:
  • Phone: 919-533-6020
  • Fax: 919-533-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN909
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-01741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: