Healthcare Provider Details

I. General information

NPI: 1841075686
Provider Name (Legal Business Name): ALEXANDER SPADEMAN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 HAROLD PL NE
ALBUQUERQUE NM
87106-2516
US

IV. Provider business mailing address

2504 HAROLD PL NE
ALBUQUERQUE NM
87106-2516
US

V. Phone/Fax

Practice location:
  • Phone: 859-492-0361
  • Fax:
Mailing address:
  • Phone: 859-492-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72806
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: