Provider Demographics
NPI:1699989277
Name:WETTGEN, SPRING LEA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:SPRING
Middle Name:LEA
Last Name:WETTGEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16278 JANINE DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-1530
Mailing Address - Country:US
Mailing Address - Phone:310-222-4167
Mailing Address - Fax:310-222-4006
Practice Address - Street 1:1000 WEST CARSON STREET
Practice Address - Street 2:BUILDING 25 BOX 468
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509-2910
Practice Address - Country:US
Practice Address - Phone:310-222-4167
Practice Address - Fax:310-222-4006
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN424006 NP14332363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics