MEDICARE: KAMIA I SPENCER RN

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	163WP2201X	Ambulatory Care Registered Nurse	RN710360	PA
2	363LA2200X	Adult Health Nurse Practitioner	SP030890	PA

General Provider Information

NPI Number	:	1558189548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMIA I SPENCER RN

Provider Business Mailing Address
First Line	:	410 BLYTHE AVE
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-5214
Country	:	US
Telephone Number	:	215-301-4206
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 BLYTHE AVE
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-5214
Country	:	US
Telephone Number	:	215-301-4206
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	10/11/2024

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