Provider Demographics
NPI:1568940179
Name:SPEARS-HOOD, ELECTISA (RN)
Entity Type:Individual
Prefix:
First Name:ELECTISA
Middle Name:
Last Name:SPEARS-HOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 N 73RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4713
Mailing Address - Country:US
Mailing Address - Phone:414-588-1337
Mailing Address - Fax:414-239-8166
Practice Address - Street 1:5019 W NORTH AVE STE 210
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1121
Practice Address - Country:US
Practice Address - Phone:414-585-0173
Practice Address - Fax:414-239-8166
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165192163WA2000X, 163WH0200X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100079511Medicaid