Basic Information
| Provider Information | |||||||||
| NPI: | 1376158790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEARS | ||||||||
| FirstName: | HAILEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10214 SQUIREHILL CT | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770703459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184095743 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16712 HUFFMEISTER RD UNIT 500 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774298050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817466037 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-131213 | TX | Y |
No ID Information.