Provider Demographics
NPI:1699199034
Name:SPITZ, SHALYNN
Entity type:Individual
Prefix:MRS
First Name:SHALYNN
Middle Name:
Last Name:SPITZ
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 1:105 E NORFOLK AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5323
Mailing Address - Country:US
Mailing Address - Phone:402-370-4204
Mailing Address - Fax:
Practice Address - Street 1:105 E NORFOLK AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5323
Practice Address - Country:US
Practice Address - Phone:402-370-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator