Provider Demographics
NPI:1104580711
Name:SPOHN, ERIC EUGENE
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:EUGENE
Last Name:SPOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10176 HEATHER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-8897
Mailing Address - Country:US
Mailing Address - Phone:574-855-7789
Mailing Address - Fax:
Practice Address - Street 1:990 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-3622
Practice Address - Country:US
Practice Address - Phone:574-936-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011771A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health