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General NPI Number Information
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NPI Number | 1366556581
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Entity Type | Individual
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Provider Name | STEPHANIE M SPENCER CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 333 LAIDLEY ST
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City | CHARLESTON
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State | WV
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Zip | 25301-1614
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Country | US
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Telephone | 304-344-0096
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Fax | 304-342-4725
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Provider Business Mailing Address
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Address Line | PO BOX 1547 CAMC PROVIDER ENROLLMENT
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City | CHARLESTON
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State | WV
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Zip | 25326-1547
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Country | US
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Telephone | 304-388-1724
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Fax | 304-388-1721
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN60156-CRNA
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License Number State | WV
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