Healthcare Provider Details

I. General information

NPI: 1184809832
Provider Name (Legal Business Name): JOYCE ANNETTE SPENCER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-6036
  • Fax: 626-744-6115
Mailing address:
  • Phone: 626-744-6036
  • Fax: 626-744-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number196796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: