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General NPI Number Information
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NPI Number | 1154089415
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Entity Type | Organization
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Legal Business Name | SPEROVUE, LLC
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 784 S CLEARWATER LOOP STE D
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City | POST FALLS
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State | ID
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Zip | 83854-9599
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Country | US
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Telephone | 208-615-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 E CENTRAL DR
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City | MERIDIAN
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State | ID
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Zip | 83642-7991
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Country | US
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Telephone | 208-615-6400
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RYAN MANWARING
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 208-615-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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