1487657052 NPI number — MS. NANCY LYNN SPENCER MSN FNP

Table of content: MS. NANCY LYNN SPENCER MSN FNP (NPI 1487657052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487657052 NPI number — MS. NANCY LYNN SPENCER MSN FNP

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
NANCY
Provider Other Middle Name:
LYNN
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:
1487657052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
10/02/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19643 SW BERNHARDT DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALOHA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-9000
Provider Business Mailing Address Fax Number:
503-494-0018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9155 SW BARNES RD
Provider Second Line Business Practice Location Address:
STE 740
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-7403
Provider Business Practice Location Address Fax Number:
503-297-3096
Provider Enumeration Date:
05/27/2005

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: 363LF0000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 275173 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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