MEDICARE: NANCY SPEARS MSW INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SWB-2024-1145	NM

General Provider Information

NPI Number	:	1003598830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY SPEARS MSW INTERN

Provider Business Mailing Address
First Line	:	4004 CARLISLE BLVD NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4566
Country	:	US
Telephone Number	:	505-585-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 CARLISLE BLVD NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4566
Country	:	US
Telephone Number	:	505-585-5024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	12/17/2025

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