Healthcare Provider Details

I. General information

NPI: 1538831102
Provider Name (Legal Business Name): CLAUDETTE JULIANNA SPENCER- MINORS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 E 52ND ST
BROOKLYN NY
11234-1617
US

IV. Provider business mailing address

1062 E 52ND ST
BROOKLYN NY
11234-1617
US

V. Phone/Fax

Practice location:
  • Phone: 917-676-5735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number307049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: