Provider Demographics
NPI:1902959604
Name:SPURLOCK, MONICA (CNM)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4464
Mailing Address - Country:US
Mailing Address - Phone:609-404-1400
Mailing Address - Fax:
Practice Address - Street 1:314 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4464
Practice Address - Country:US
Practice Address - Phone:609-404-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00030801176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223524101OtherTAX ID