Healthcare Provider Details

I. General information

NPI: 1457800468
Provider Name (Legal Business Name): THERESA SPAKOWSKI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA COOPER

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-6000
  • Fax:
Mailing address:
  • Phone: 660-890-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2004018100
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016035600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: