Healthcare Provider Details

I. General information

NPI: 1609045178
Provider Name (Legal Business Name): VALERIE SPENCER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 1ST ST
TUCUMCARI NM
88401-2707
US

IV. Provider business mailing address

PO BOX 628
TUCUMCARI NM
88401-0628
US

V. Phone/Fax

Practice location:
  • Phone: 575-461-2222
  • Fax: 575-461-2255
Mailing address:
  • Phone: 575-461-2222
  • Fax: 575-461-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR63323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: