1013159169 NPI number — MS. WANDA LYNN SPENCER ED.S.

Table of content: MS. WANDA LYNN SPENCER ED.S. (NPI 1013159169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013159169 NPI number — MS. WANDA LYNN SPENCER ED.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
WANDA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENTON
Provider Other First Name:
WANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013159169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 1ST AVE SW
Provider Second Line Business Mailing Address:
SUITE 202 C
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-636-7411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 1ST AVE SW
Provider Second Line Business Practice Location Address:
SUITE 202 C
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-361-1333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  11507 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)