Healthcare Provider Details

I. General information

NPI: 1518123520
Provider Name (Legal Business Name): NICOLE JEANETTE SPENCER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N FRANCISCO AVE
CHICAGO IL
60625-3611
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2570
  • Fax: 847-933-3520
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-570-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036126475
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: