Provider Demographics
NPI:1013427996
Name:SPOONER, CARLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:SPOONER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9619
Mailing Address - Country:US
Mailing Address - Phone:585-230-6993
Mailing Address - Fax:
Practice Address - Street 1:160 SAWGRASS DR STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4655
Practice Address - Country:US
Practice Address - Phone:585-262-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342335363L00000X
NYF342335-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner