Provider Demographics
NPI:1649641689
Name:SPADONI, KATHLEEN MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:SPADONI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:KASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 BELMONT ST
Mailing Address - Street 2:WORCESTER INTERNAL MEDICINE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1086
Mailing Address - Country:US
Mailing Address - Phone:508-756-6609
Mailing Address - Fax:508-798-0538
Practice Address - Street 1:416 BELMONT ST
Practice Address - Street 2:WORCESTER INTERNAL MEDICINE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1086
Practice Address - Country:US
Practice Address - Phone:508-756-6609
Practice Address - Fax:508-798-0538
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily