Individual
BONITA A SPADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP,CDE
Contact information
Practice address
2845 TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 797-1770
(843) 553-1498
Mailing address
2845 TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 797-1770
(843) 553-1498
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R64665
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0283
—
SC
01
—
R64665
SC STATE ID #
SC
Enumeration date
11/29/2006
Last updated
07/09/2007
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