Provider Demographics
NPI:1447069158
Name:SPAULDING, JASON W (RN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MENAUL BLVD NE UNIT 501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1562
Mailing Address - Country:US
Mailing Address - Phone:505-274-1252
Mailing Address - Fax:
Practice Address - Street 1:601 MENAUL BLVD NE UNIT 501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1562
Practice Address - Country:US
Practice Address - Phone:505-274-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR55555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse