Healthcare Provider Details

I. General information

NPI: 1992485254
Provider Name (Legal Business Name): SUSANNA L SPEARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 TIMBERLINE DR
SANFORD NC
27332-8619
US

IV. Provider business mailing address

86 TIMBERLINE DR
SANFORD NC
27332-8619
US

V. Phone/Fax

Practice location:
  • Phone: 919-820-2285
  • Fax:
Mailing address:
  • Phone: 919-820-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: