=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699650549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN A SPENCER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2025
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6166 DOWNS RIDGE CT
-----------------------------------------------------
City | ELKRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21075-6550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-889-5003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6166 DOWNS RIDGE CT
-----------------------------------------------------
City | ELKRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21075-6550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-914-8765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0630X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
-----------------------------------------------------
License Number | W26176891
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------