Healthcare Provider Details

I. General information

NPI: 1790082493
Provider Name (Legal Business Name): CAROLYN T SPAWN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 S 4TH ST
FULTON NY
13069-1859
US

IV. Provider business mailing address

167 S 4TH ST
FULTON NY
13069-1859
US

V. Phone/Fax

Practice location:
  • Phone: 315-593-8608
  • Fax:
Mailing address:
  • Phone: 315-593-8608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number311459-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: