Provider Demographics
NPI:1578826210
Name:SPANN, MARY ANN (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:SPANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4626 HIGHWAY 565
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-5545
Mailing Address - Country:US
Mailing Address - Phone:318-757-6271
Mailing Address - Fax:318-757-7654
Practice Address - Street 1:905 MICKEY GILLEY AVE
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2619
Practice Address - Country:US
Practice Address - Phone:318-757-6271
Practice Address - Fax:318-757-7654
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN063002163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health