Individual
LISA SPEARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6326 CONSTITUTION DR, FORT WAYNE, IN 46804-1518
(260) 515-3275
Mailing address
429 E DUPONT RD # 1103, FORT WAYNE, IN 46825-2051
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28248812C
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71015758A
IN
Other
Enumeration date
08/27/2024
Last updated
09/16/2024
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