Healthcare Provider Details

I. General information

NPI: 1457124638
Provider Name (Legal Business Name): MANDY MARIE SPERLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 KERNERSVILLE MEDICAL PKWY STE 101
KERNERSVILLE NC
27284-7198
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-564-4950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019095
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: