Healthcare Provider Details

I. General information

NPI: 1669575080
Provider Name (Legal Business Name): JANE D SPOONER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE D TABER RN

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VALLEY ROAD NCCMHC
MIDDLETOWN RI
02842
US

IV. Provider business mailing address

26 VALLEY ROAD NCCMHC
MIDDLETOWN RI
02842
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-6363
  • Fax: 401-848-6389
Mailing address:
  • Phone: 401-848-6363
  • Fax: 401-848-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN17552
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: