Healthcare Provider Details

I. General information

NPI: 1992474795
Provider Name (Legal Business Name): STEPHANIE CLAIRE SPENCER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MINERAL AVE
BOZEMAN MT
59718-6247
US

IV. Provider business mailing address

319 MINERAL AVE
BOZEMAN MT
59718-6247
US

V. Phone/Fax

Practice location:
  • Phone: 832-785-7513
  • Fax:
Mailing address:
  • Phone: 832-785-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number178226
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-178226
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberNUR-RN-LIC-178225
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: