Provider Demographics
NPI:1659629160
Name:SPOONHOWER, MARY ELLEN (LPN)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:SPOONHOWER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12433 STATE ROUTE 38
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-2324
Mailing Address - Country:US
Mailing Address - Phone:607-201-5568
Mailing Address - Fax:
Practice Address - Street 1:12433 STATE ROUTE 38
Practice Address - Street 2:
Practice Address - City:BERKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:13736-2324
Practice Address - Country:US
Practice Address - Phone:607-201-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234024-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse