Provider Demographics
NPI:1912301656
Name:SPAIN, JANINE GIBSON (RN)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:GIBSON
Last Name:SPAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BUTTERCUP CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016
Mailing Address - Country:US
Mailing Address - Phone:803-785-6626
Mailing Address - Fax:803-602-2069
Practice Address - Street 1:2000 HAMPTON STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-785-6626
Practice Address - Fax:803-602-2069
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse