Healthcare Provider Details

I. General information

NPI: 1689615775
Provider Name (Legal Business Name): ELSIE M SPENCER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 MEDICAL PARK CT
MOREHEAD CITY NC
28557-4346
US

IV. Provider business mailing address

306 MEDICAL PARK CT
MOREHEAD CITY NC
28557-4346
US

V. Phone/Fax

Practice location:
  • Phone: 252-247-2013
  • Fax:
Mailing address:
  • Phone: 252-247-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201277
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: