Provider Demographics
NPI:1245501782
Name:SPAINE, GUSTAVUS AINA (RN)
Entity type:Individual
Prefix:MR
First Name:GUSTAVUS
Middle Name:AINA
Last Name:SPAINE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9435 EAGLEWOOD SPRING DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5130
Mailing Address - Country:US
Mailing Address - Phone:713-516-7841
Mailing Address - Fax:281-302-5345
Practice Address - Street 1:9435 EAGLEWOOD SPRING DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5130
Practice Address - Country:US
Practice Address - Phone:713-516-7841
Practice Address - Fax:281-302-5345
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794317163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse