Healthcare Provider Details

I. General information

NPI: 1518284629
Provider Name (Legal Business Name): ELIZABETH CATHERINE SPENCE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 W JUDGE PEREZ DR
ARABI LA
70032-1919
US

IV. Provider business mailing address

27709 AUTUMN WOODS CIR
LOXLEY AL
36551-3128
US

V. Phone/Fax

Practice location:
  • Phone: 504-281-2800
  • Fax:
Mailing address:
  • Phone: 301-461-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN123535-AP06109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: