Provider Demographics
NPI:1487792727
Name:SPEARS, PEARLINE (LVN)
Entity type:Individual
Prefix:MRS
First Name:PEARLINE
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:PEARLINE
Other - Middle Name:SPEARS
Other - Last Name:GRADDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8350 COPPERSIDE
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3904
Mailing Address - Country:US
Mailing Address - Phone:210-945-8946
Mailing Address - Fax:210-945-8946
Practice Address - Street 1:8350 COPPERSIDE
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3904
Practice Address - Country:US
Practice Address - Phone:210-945-8946
Practice Address - Fax:210-945-8946
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83102164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse