Provider Demographics
NPI:1467078139
Name:SPYR, RACQUEL JILLIAN
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:JILLIAN
Last Name:SPYR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 S PARKCREST ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8839
Mailing Address - Country:US
Mailing Address - Phone:928-208-1311
Mailing Address - Fax:
Practice Address - Street 1:837 S PARKCREST ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8839
Practice Address - Country:US
Practice Address - Phone:928-208-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily