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General NPI Number Information
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NPI Number | 1407715600
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Entity Type | Individual
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Provider Name | WILLARD C. SPURLOCK
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Gender | Male
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 14901 W 102ND AVE
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City | DYER
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State | IN
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Zip | 46311-7750
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Country | US
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Telephone | 708-271-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 14901 W 102ND AVE
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City | DYER
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State | IN
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Zip | 46311-7750
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Country | US
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Telephone | 708-271-0390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 28268894C
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License Number State | IN
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