Healthcare Provider Details

I. General information

NPI: 1871443887
Provider Name (Legal Business Name): STEPHANIE SPENCER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 302
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

2535 SUNSET DR APT Q359
LONGMONT CO
80501-7528
US

V. Phone/Fax

Practice location:
  • Phone: 303-684-1900
  • Fax:
Mailing address:
  • Phone: 214-934-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number915966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: