Healthcare Provider Details

I. General information

NPI: 1427342740
Provider Name (Legal Business Name): DONNA ANTON SPAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 PACKARD AVE STE 100
MARYSVILLE CA
95901-7117
US

IV. Provider business mailing address

459-220 CARTWRIGHT RD
JANESVILLE CA
96114-9456
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-6366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number79075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN68068
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: