Healthcare Provider Details

I. General information

NPI: 1184171456
Provider Name (Legal Business Name): STEPHANIE SPENCER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 18TH ST
RICHMOND VA
23223-6905
US

IV. Provider business mailing address

PO BOX 4255
RICHMOND VA
23220-8255
US

V. Phone/Fax

Practice location:
  • Phone: 321-333-2535
  • Fax:
Mailing address:
  • Phone: 321-333-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1127158
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number0001227158
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0001227158
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number0001227158
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number0001227158
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number0001227158
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001227158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: