Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015025652 | MO |
NPI | 1003282864 |
---|---|
Provider Name | Michelle Spencer |
First Address | Springfield, MO 65810-2501 |
Second Address | Springfield, MO 65803-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |