Provider Demographics
NPI:1962628792
Name:SPINNER, ELLEN COLEEN (MS, CNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:COLEEN
Last Name:SPINNER
Suffix:
Gender:F
Credentials:MS, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9002
Mailing Address - Country:US
Mailing Address - Phone:937-834-1710
Mailing Address - Fax:937-834-1712
Practice Address - Street 1:1835 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-5210
Practice Address - Country:US
Practice Address - Phone:937-328-0710
Practice Address - Fax:937-328-0711
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11061209OtherCAQH PROVIDER ID
OH2668411OMedicaid