Healthcare Provider Details

I. General information

NPI: 1992887996
Provider Name (Legal Business Name): MONITA SPANN CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ROGERS AVE SUITE 401
FORT SMITH AR
72903-4073
US

IV. Provider business mailing address

11023 HUNTERS POINT RD
FORT SMITH AR
72903-5846
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-1188
  • Fax: 479-452-1196
Mailing address:
  • Phone: 918-688-9171
  • Fax: 479-223-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberF01335
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberF01335
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: