Healthcare Provider Details

I. General information

NPI: 1205551207
Provider Name (Legal Business Name): SPENCER ELIZABETH WARREN NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E BASELINE RD STE D208
TEMPE AZ
85283-1298
US

IV. Provider business mailing address

123 E BASELINE RD STE D208
TEMPE AZ
85283-1298
US

V. Phone/Fax

Practice location:
  • Phone: 480-914-0521
  • Fax: 480-914-0522
Mailing address:
  • Phone: 480-914-0521
  • Fax: 480-914-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number22-1747
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: