Provider Demographics
NPI:1891024261
Name:SPAIN, SCARLET RAE (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SCARLET
Middle Name:RAE
Last Name:SPAIN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3210 WATLING ST
Mailing Address - Street 2:MEDICAL DEPT. 8-210
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-1716
Mailing Address - Country:US
Mailing Address - Phone:219-399-3133
Mailing Address - Fax:219-399-5814
Practice Address - Street 1:3210 WATLING ST
Practice Address - Street 2:MEDICAL DEPT. 8-210
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-1716
Practice Address - Country:US
Practice Address - Phone:219-399-3133
Practice Address - Fax:219-399-5814
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28160228A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily