Basic Information
| Provider Information | |||||||||
| NPI: | 1447583109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPIDLE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 SAN JOAQUIN DR | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960802244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305287613 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1860 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | RED B;UFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305275637 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 09/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 484020 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.