Healthcare Provider Details

I. General information

NPI: 1659321255
Provider Name (Legal Business Name): JANIE M SPOON MSN, RNC, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD SUITE 2718
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

4401 WORNALL RD SUITE 2718
KANSAS CITY MO
64111-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2493
  • Fax:
Mailing address:
  • Phone: 816-932-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number13-73232-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: