Provider Demographics
NPI:1992887996
Name:SPANN, MONITA (CSFA)
Entity type:Individual
Prefix:MS
First Name:MONITA
Middle Name:
Last Name:SPANN
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 HUNTERS POINT RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5846
Mailing Address - Country:US
Mailing Address - Phone:918-688-9171
Mailing Address - Fax:479-223-3369
Practice Address - Street 1:7001 ROGERS AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4073
Practice Address - Country:US
Practice Address - Phone:479-452-1188
Practice Address - Fax:479-452-1196
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF01335246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF01335OtherFIRST ASSISTANT CERTIFICA