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General NPI Number Information
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NPI Number | 1215385463
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Entity Type | Organization
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Legal Business Name | PROSPER AT HOME HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 7319 YELLOWHORN TRL
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City | WAXHAW
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State | NC
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Zip | 28173-7465
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Country | US
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Telephone | 704-907-0537
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Fax |
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Provider Business Mailing Address
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Address Line | 7319 YELLOWHORN TRL
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City | WAXHAW
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State | NC
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Zip | 28173-7465
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Country | US
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Telephone | 704-907-0537
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR/HEAD NP
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Name | MRS. SHAWANDA LESTER SPENCER
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Credential | NP-C
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Telephone | 704-907-0537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0516317
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License Number State | NC
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