MEDICARE: KAY 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	163W00000X	Registered Nurse	4704114371	MI

General Provider Information

NPI Number	:	1912494642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY SPENCER RN

Provider Business Mailing Address
First Line	:	3369 MILES RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8707
Country	:	US
Telephone Number	:	517-962-4861
Fax Number	:	517-962-4596

Provider Business Practice Location Address
First Line	:	3369 MILES RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8707
Country	:	US
Telephone Number	:	517-962-4861
Fax Number	:	517-962-4596

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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