Provider Demographics
NPI:1649435413
Name:SPOONER, CAROL ANNE (NMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:SPOONER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:SPOONER MEUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NMD
Mailing Address - Street 1:6106 E BROWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4954
Mailing Address - Country:US
Mailing Address - Phone:480-833-0302
Mailing Address - Fax:480-833-0904
Practice Address - Street 1:6106 E BROWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4954
Practice Address - Country:US
Practice Address - Phone:480-833-0302
Practice Address - Fax:480-833-0904
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08-151175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
081051OtherNATUROPATHIC MEDICAL LICENSE FOR ARIZONA