Provider Demographics
NPI:1134295710
Name:SPOONER, DIANE C (RHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:SPOONER
Suffix:
Gender:F
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20328
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89515-0328
Mailing Address - Country:US
Mailing Address - Phone:775-982-3559
Mailing Address - Fax:775-972-6904
Practice Address - Street 1:1495 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1479
Practice Address - Country:US
Practice Address - Phone:775-982-3559
Practice Address - Fax:775-972-6904
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2616082Medicaid
NV2616082Medicaid
R61865Medicare UPIN