Provider Demographics
NPI:1124860879
Name:SPADAFORA, MARY MARGARET (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:SPADAFORA
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 1:7921 W BECHER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1041
Mailing Address - Country:US
Mailing Address - Phone:414-759-2022
Mailing Address - Fax:
Practice Address - Street 1:7921 W BECHER ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1041
Practice Address - Country:US
Practice Address - Phone:414-759-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68292163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health