Provider Demographics
NPI:1124073911
Name:SPAHN, JUDITH K (APNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:SPAHN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 W KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5368
Mailing Address - Country:US
Mailing Address - Phone:563-388-7000
Mailing Address - Fax:563-388-7001
Practice Address - Street 1:2162 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5368
Practice Address - Country:US
Practice Address - Phone:563-388-7000
Practice Address - Fax:563-388-7001
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001288363LA2100X
WI2838363L00000X
IAA084351363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90080OtherTRICARE
P00251727OtherRAILROAD MEDICARE
106692OtherHEALTH ALLIANCE
ILS90080OtherBLUE CROSS BLUE SHIELD
106692OtherHEALTH ALLIANCE
S90080OtherTRICARE