Healthcare Provider Details

I. General information

NPI: 1821059742
Provider Name (Legal Business Name): NANCY LYNN SPENCER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 203
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3277
  • Fax: 518-262-4210
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: