Provider Demographics
NPI:1568688299
Name:SPOONER, SUZANNE M (CRNFA, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:SPOONER
Suffix:
Gender:F
Credentials:CRNFA, AGACNP-BC
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE B500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1787
Mailing Address - Fax:304-691-8711
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1787
Practice Address - Fax:304-691-8711
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN232154163WR0006X
WV89479363LG0600X
OHAPRN.CNP.0026801363LG0600X
WVAPRN89479-ACNPC-AG363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065567Medicaid