MEDICARE: WENDY SPELLUN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN00540	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	709004155	OTHER	RI	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	406773	OTHER	RI	BLUE CHIP
4	2849-7	OTHER	RI	BCBS OF RI

General Provider Information

NPI Number	:	1811982374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY SPELLUN NP

Provider Business Mailing Address
First Line	:	10 DAVOL SQ
Second Line	:	SUITE 400
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-4754
Country	:	US
Telephone Number	:	401-421-4000
Fax Number	:	401-272-1456

Provider Business Practice Location Address
First Line	:	900 WARREN AVE
Second Line	:	SUITE 401
City	:	EAST PROVIDENCE
State	:	RI
Zip	:	02914-1430
Country	:	US
Telephone Number	:	800-508-4908
Fax Number	:	401-228-6236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/31/2016

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Directions to “ WENDY SPELLUN NP” Practice Location

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