Healthcare Provider Details

I. General information

NPI: 1114896784
Provider Name (Legal Business Name): MARIAH SPAYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 9TH ST
JASPER IN
47546-2514
US

IV. Provider business mailing address

2343 S 800 E
SCHNELLVILLE IN
47580-9715
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-2345
  • Fax:
Mailing address:
  • Phone: 812-827-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28230615A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: