Provider Demographics
NPI:1730561770
Name:SPUDIS, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SPUDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18772 KINSPORT LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3194
Mailing Address - Country:US
Mailing Address - Phone:302-448-0626
Mailing Address - Fax:
Practice Address - Street 1:18772 KINSPORT LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3194
Practice Address - Country:US
Practice Address - Phone:302-448-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0042115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse