MEDICARE: SHARON L SPEAR NP

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	363LA2200X	Adult Health Nurse Practitioner	71004075A	IN
2	363LA2200X	Adult Health Nurse Practitioner	71004075B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71004075	OTHER	IN	LICENSE

General Provider Information

NPI Number	:	1285074088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON L SPEAR NP

Provider Business Mailing Address
First Line	:	5010 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6804
Country	:	US
Telephone Number	:	260-436-1248
Fax Number	:	260-436-7968

Provider Business Practice Location Address
First Line	:	5010 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6804
Country	:	US
Telephone Number	:	260-436-1248
Fax Number	:	260-436-7968

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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