Provider Demographics
NPI:1699225201
Name:SPAULDING, CARLYE
Entity type:Individual
Prefix:
First Name:CARLYE
Middle Name:
Last Name:SPAULDING
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-0278
Mailing Address - Country:US
Mailing Address - Phone:971-983-5260
Mailing Address - Fax:
Practice Address - Street 1:4680 MARIPOSA LN
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:CO
Practice Address - Zip Code:80809-1807
Practice Address - Country:US
Practice Address - Phone:719-640-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608223CRNA-PP367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered