Provider Demographics
NPI:1891333183
Name:SPEAR, SUSAN JOANN (RN)
Entity Type:Individual
Prefix:MR
First Name:SUSAN
Middle Name:JOANN
Last Name:SPEAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOANN
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3400 N WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6712
Mailing Address - Country:US
Mailing Address - Phone:479-636-3190
Mailing Address - Fax:479-636-4587
Practice Address - Street 1:3400 N WOODS LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6712
Practice Address - Country:US
Practice Address - Phone:479-636-3190
Practice Address - Fax:479-636-4587
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR084531163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR084531OtherRN LICENSE