Individual
JONATHAN BANNING SPIVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 TILGHMAN DR, DUNN, NC 28334-5510
(910) 892-1000
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
001626
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051809
—
NC
01
—
P00284830
RAILROAD-MEDICARE
NC
Enumeration date
01/22/2007
Last updated
10/12/2022
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