Provider Demographics
NPI:1023649464
Name:SPEAR, SUSAN (MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 S CUPERTINO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0402
Mailing Address - Country:US
Mailing Address - Phone:480-825-5206
Mailing Address - Fax:
Practice Address - Street 1:3321 E QUEEN CREEK RD STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8530
Practice Address - Country:US
Practice Address - Phone:602-456-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist