Healthcare Provider Details

I. General information

NPI: 1871649855
Provider Name (Legal Business Name): LINDA JEAN SPOONHUNTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 N TU SU LN
BISHOP CA
93514-8058
US

IV. Provider business mailing address

PO BOX 254
BIG PINE CA
93513-0254
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-7611
  • Fax: 760-873-3361
Mailing address:
  • Phone: 760-938-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberRN500519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: