MEDICARE: MRS. JANELLA M SPEARS RN-C

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	374T00000X	Religious Nonmedical Nursing Personnel	82008087	OR

General Provider Information

NPI Number	:	1841437993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANELLA M SPEARS RN-C

Provider Business Mailing Address
First Line	:	PO BOX 255
Second Line	:	5401 POPLAR ST
City	:	FOSTER
State	:	OR
Zip	:	97345-0255
Country	:	US
Telephone Number	:	541-367-8012
Fax Number	:	541-367-8012

Provider Business Practice Location Address
First Line	:	5401 POPLAR ST
Second Line	:
City	:	FOSTER
State	:	OR
Zip	:	97345-0255
Country	:	US
Telephone Number	:	541-367-8012
Fax Number	:	541-367-8012

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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