Healthcare Provider Details

I. General information

NPI: 1831701788
Provider Name (Legal Business Name): AMBER JANINE SPENCER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 TACOMA AVE S STE 305
TACOMA WA
98402-1903
US

IV. Provider business mailing address

1305 TACOMA AVE S STE 305
TACOMA WA
98402-1903
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax: 253-396-5173
Mailing address:
  • Phone:
  • Fax: 253-396-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN60540000
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN60540000
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61327484
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: