Provider Demographics
NPI:1235282492
Name:SPALDING, N DIANE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:N
Middle Name:DIANE
Last Name:SPALDING
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-886-6711
Mailing Address - Fax:573-814-2784
Practice Address - Street 1:1001 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2037
Practice Address - Country:US
Practice Address - Phone:573-886-6711
Practice Address - Fax:573-814-2784
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0363047-22OtherAMERICAN NURSES CREDENTIA
MO062341OtherMO STATE BOARD OF NURSING
MO1235282492Medicaid
MO1235282492Medicaid