Healthcare Provider Details

I. General information

NPI: 1376474254
Provider Name (Legal Business Name): REGAN SPANBAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 E CHASEWOOD DR
AMMON ID
83406-4007
US

IV. Provider business mailing address

6149 N SILVER FOX RD APT 1
IDAHO FALLS ID
83401-1048
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax:
Mailing address:
  • Phone: 208-936-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7381316
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: