Healthcare Provider Details

I. General information

NPI: 1306219571
Provider Name (Legal Business Name): MICHELLE ASHLEY SPENCE C.N.A., E.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 E 1ST ST
LONG BEACH CA
90803-2519
US

IV. Provider business mailing address

2916 E 1ST ST
LONG BEACH CA
90803-2519
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-1799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00662552
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberE3216132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: