Provider Demographics
NPI:1669575080
Name:SPOONER, JANE D (RN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:D
Last Name:SPOONER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:D
Other - Last Name:TABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26 VALLEY ROAD
Mailing Address - Street 2:NCCMHC
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-848-6363
Mailing Address - Fax:401-848-6389
Practice Address - Street 1:26 VALLEY ROAD
Practice Address - Street 2:NCCMHC
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-848-6363
Practice Address - Fax:401-848-6389
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN17552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJS56578Medicaid