Provider Demographics
NPI:1891050266
Name:SPEARS, SUSAN ELENA (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELENA
Last Name:SPEARS
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 1:1100 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-9625
Mailing Address - Country:US
Mailing Address - Phone:541-910-2173
Mailing Address - Fax:
Practice Address - Street 1:1100 S 3RD ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883-9625
Practice Address - Country:US
Practice Address - Phone:541-910-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093000573RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse