Healthcare Provider Details

I. General information

NPI: 1134156599
Provider Name (Legal Business Name): LINDA C SPENCER RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDRENS HOSPITAL MI NEPHROLOGY 3901 BEAUBIEN 2ND FLOOR - CARL'S BUILDING
DETROIT MI
48201
US

IV. Provider business mailing address

3800 WOODWARD AVE SUITE 702
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5604
  • Fax: 313-966-0039
Mailing address:
  • Phone: 313-262-1303
  • Fax: 313-262-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704160416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: