Individual
MATTEA ROSE SPAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704340419
MI
163WG0600X
Gerontology Registered Nurse
243214
WI
Other
Enumeration date
05/31/2022
Last updated
09/26/2022
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