Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 451990 | CA |
NPI | 1164613394 |
---|---|
Provider Name | Mrs. Colette Mary Spencer |
First Address | Los Angeles, CA 90045-3807 |
Second Address | Los Angeles, CA 90045-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 27/12/2010 |