Basic Information
| Provider Information | |||||||||
| NPI: | 1992887996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPANN | ||||||||
| FirstName: | MONITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11023 HUNTERS POINT RD | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729035846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186889171 | ||||||||
| FaxNumber: | 4792233369 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 ROGERS AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729034073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794521188 | ||||||||
| FaxNumber: | 4794521196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | F01335 | OK | N | 246ZC0007X | F01335 | OK | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
ID Information
| ID | Type | State | Issuer | Description | F01335 | 01 | OK | FIRST ASSISTANT CERTIFICA | OTHER |