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General NPI Number Information
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NPI Number | 1639344039
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Entity Type | Individual
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Provider Name | SUSAN TARK SPINELLO CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 250 KING OF PRUSSIA RD
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City | RADNOR
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State | PA
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Zip | 19087-5220
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Country | US
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Telephone | 610-902-5618
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Fax | 610-902-2051
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Provider Business Mailing Address
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Address Line | 13 TALL TREE CIR
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City | BROOMALL
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State | PA
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Zip | 19008-1027
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Country | US
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Telephone | 610-902-5618
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Fax | 610-902-2051
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | UP004720C
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License Number State | PA
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