Provider Demographics
NPI:1699108167
Name:SPOONER, KRISTEN MARGARET (LPN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARGARET
Last Name:SPOONER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARGARET
Other - Last Name:DESROSIERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7713 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1120
Mailing Address - Country:US
Mailing Address - Phone:315-523-5355
Mailing Address - Fax:
Practice Address - Street 1:7713 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1120
Practice Address - Country:US
Practice Address - Phone:315-523-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse