Healthcare Provider Details

I. General information

NPI: 1770574113
Provider Name (Legal Business Name): PATRICIA SPENCER-CISEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST
GLENS FALLS NY
12801-4449
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-6545
  • Fax: 518-926-1954
Mailing address:
  • Phone: 518-926-6545
  • Fax: 518-926-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number302969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: