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NPI Code Detail

MEDICARE: MRS. REBECCA SUE SPENCE RN,C

MEDICARE:  MRS. REBECCA SUE SPENCE  RN,C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704186991MI

General Provider Information

NPI Number : 1154453249
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA SUE SPENCE RN,C
Provider Business Mailing Address
First Line : 1256 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4067
Country : US
Telephone Number : 616-647-2590
Fax Number : 616-647-2585
Provider Business Practice Location Address
First Line : 1256 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4067
Country : US
Telephone Number : 616-647-2590
Fax Number : 616-647-2585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. REBECCA SUE SPENCE RN,C” Practice Location

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