1649435413 NPI number — DR. CAROL ANNE SPOONER NMD

Table of content: DR. CAROL ANNE SPOONER NMD (NPI 1649435413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649435413 NPI number — DR. CAROL ANNE SPOONER NMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPOONER
Provider First Name:
CAROL
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
NMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPOONER MEUSE
Provider Other First Name:
CAROL
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649435413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6106 E BROWN RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-4954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-833-0302
Provider Business Mailing Address Fax Number:
480-833-0904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6106 E BROWN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85205-4954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-833-0302
Provider Business Practice Location Address Fax Number:
480-833-0904
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  08-151 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 081051 . This is a "NATUROPATHIC MEDICAL LICENSE FOR ARIZONA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com