=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962366773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH SPONSELLER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 BERMUDA BAY LN APT 208
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302-9862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-383-2163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 BERMUDA BAY LN APT 208
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302-9862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 371247
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------