Provider Demographics
NPI:1427342740
Name:ANTON SPAAN, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ANTON SPAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459-220 CARTWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96114-9456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5730 PACKARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7117
Practice Address - Country:US
Practice Address - Phone:530-749-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79075163WC0400X
NVRN68068163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management