Provider Demographics
NPI:1144547654
Name:SPELLMAN, ALEXANDRA DARE (RN)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:DARE
Last Name:SPELLMAN
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 1:160 HAMILTON PL
Mailing Address - Street 2:APT 2
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4062
Mailing Address - Country:US
Mailing Address - Phone:920-924-0120
Mailing Address - Fax:920-924-0120
Practice Address - Street 1:160 HAMILTON PL
Practice Address - Street 2:APT 2
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4062
Practice Address - Country:US
Practice Address - Phone:920-924-0120
Practice Address - Fax:920-924-0120
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156123-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice