Provider Demographics
NPI:1881228781
Name:SPEARS, CONNIE (FNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5111
Mailing Address - Country:US
Mailing Address - Phone:208-553-0057
Mailing Address - Fax:
Practice Address - Street 1:215 10TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1910
Practice Address - Country:US
Practice Address - Phone:208-799-3100
Practice Address - Fax:208-799-0349
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily