=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205535945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEER PRIMARY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2023
-----------------------------------------------------
Last Update Date | 06/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 CARLISLE DR STE A
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-794-3741
-----------------------------------------------------
Fax | 888-873-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 CARLISLE DR STE A
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-794-3741
-----------------------------------------------------
Fax | 800-873-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | JANICE SPEER
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 703-501-0107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------