Provider Demographics
NPI:1568036663
Name:SPINNIE, KASSANDRA JUNE
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:JUNE
Last Name:SPINNIE
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 1:1075 N CURTIS ROAD
Mailing Address - Street 2:BLDG N6, SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1300
Mailing Address - Country:US
Mailing Address - Phone:208-377-5166
Mailing Address - Fax:208-375-0599
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:BLDG. N6, SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-377-5166
Practice Address - Fax:208-375-0599
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily