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General NPI Number Information
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NPI Number | 1427706233
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Entity Type | Organization
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Legal Business Name | LA-NP PSYCHIATRIC MENTAL-HEALTH , PLC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 11900 TIDELINE CIR
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City | CHESTER
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State | VA
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Zip | 23836-5437
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Country | US
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Telephone | 856-404-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 11900 TIDELINE CIR
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City | CHESTER
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State | VA
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Zip | 23836-5437
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Country | US
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Telephone | 856-404-5794
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LISA OLANDA SPURLOCK
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Credential | NP- PSYCHIATRIC MH
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Telephone | 856-404-5794
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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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