1386140994 NPI number — MRS. NICOLE ELVEINA SPENCE LPN

Table of content: MRS. NICOLE ELVEINA SPENCE LPN (NPI 1386140994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386140994 NPI number — MRS. NICOLE ELVEINA SPENCE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCE
Provider First Name:
NICOLE
Provider Middle Name:
ELVEINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INNIS
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ELVEINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386140994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 FOREST DR APT K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNERVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10923-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-461-1555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SCHRIEVER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-613-7838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2018

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: 164W00000X , with the licence number:  292879 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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