Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19243 | PR |
NPI | 1013145812 |
---|---|
Provider Name | Dr. Nicolle Spence |
First Address | Bayamon, PR 00961-7052 |
Second Address | Bayamon, PR 00961-7052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 06/08/2016 |