Healthcare Provider Details

I. General information

NPI: 1952969925
Provider Name (Legal Business Name): DANIELLE MARIE SPENCER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SW MULVANE ST STE 330
TOPEKA KS
66606-1679
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-9591
  • Fax: 785-354-0519
Mailing address:
  • Phone: 785-623-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02280
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: