MEDICARE: BRIAN SPENCE MSW, APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.025278	OH

General Provider Information

NPI Number	:	1083268718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SPENCE MSW, APRN-CNP

Provider Business Mailing Address
First Line	:	2860 DETROIT AVE APT 103
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-2741
Country	:	US
Telephone Number	:	419-357-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 W EXCHANGE ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44302-1306
Country	:	US
Telephone Number	:	216-432-7200
Fax Number	:	330-787-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	02/13/2024

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