Provider Demographics
NPI:1942016415
Name:SPANN, JANDI
Entity type:Individual
Prefix:
First Name:JANDI
Middle Name:
Last Name:SPANN
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 1:4351 S RANCH HOUSE PKWY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7049
Mailing Address - Country:US
Mailing Address - Phone:480-279-7600
Mailing Address - Fax:
Practice Address - Street 1:6922 S GEMSTONE PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7217
Practice Address - Country:US
Practice Address - Phone:480-796-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045163164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse