Individual
MANDY REBECCA SPANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CLC
Contact information
Practice address
1932 GREENMEADOW DR, WALLED LAKE, MI 48390-2532
(248) 496-2565
Mailing address
1932 GREENMEADOW DR, WALLED LAKE, MI 48390-2532
(248) 496-2565
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704244162
MI
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
307324
MI
Other
Enumeration date
08/04/2018
Last updated
08/04/2018
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