MEDICARE: MR. JASON W SPAULDING RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R55555	NM

General Provider Information

NPI Number	:	1447069158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON W SPAULDING RN

Provider Business Mailing Address
First Line	:	601 MENAUL BLVD NE UNIT 501
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1562
Country	:	US
Telephone Number	:	505-274-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 MENAUL BLVD NE UNIT 501
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1562
Country	:	US
Telephone Number	:	505-274-1252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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