Healthcare Provider Details

I. General information

NPI: 1699225201
Provider Name (Legal Business Name): CARLYE SPAULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 MARIPOSA LN
CASCADE CO
80809-1807
US

IV. Provider business mailing address

PO BOX 278
WOODBURN OR
97071-0278
US

V. Phone/Fax

Practice location:
  • Phone: 719-640-6860
  • Fax:
Mailing address:
  • Phone: 971-983-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201608223CRNA-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: