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General NPI Number Information
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NPI Number | 1063204469
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Entity Type | Individual
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Provider Name | IVANA SPENCER
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1601 WILLOW LAWN DR STE 304 THE SHOPS AT WILLOW LAWN #1283
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City | RICHMOND
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State | VA
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Zip | 23230-3423
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Country | US
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Telephone | 804-825-2308
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Fax | 804-964-9870
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Provider Business Mailing Address
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Address Line | 1601 WILLOW LAWN DR STE. 304, THE SHOPS AT WILLOW LAWN #1283
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City | RICHMOND
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State | VA
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Zip | 23230-3427
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Country | US
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Telephone | 757-793-9483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024194447
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001284498
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License Number State | VA
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