Healthcare Provider Details

I. General information

NPI: 1922417997
Provider Name (Legal Business Name): COLETTE SPENCER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 W EASTMAN PL
LAKEWOOD CO
80227-6355
US

IV. Provider business mailing address

1911 WILLOW RIDGE DR
VISTA CA
92081-7367
US

V. Phone/Fax

Practice location:
  • Phone: 949-637-1747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0182705
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number678431
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200843309
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: