MEDICARE: SIMONE M SPENCER CNM

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
1	176B00000X	Midwife	F001074-1	NY
2	363L00000X	Nurse Practitioner	R224419	MD
3	367A00000X	Advanced Practice Midwife	R224419	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174521256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE M SPENCER CNM

Provider Business Mailing Address
First Line	:	3501 SINCLAIR LN
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-2029
Country	:	US
Telephone Number	:	410-732-8800
Fax Number	:	443-703-3242

Provider Business Practice Location Address
First Line	:	1245 EASTERN BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21221-3422
Country	:	US
Telephone Number	:	410-558-4700
Fax Number	:	410-780-0364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/12/2022

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Directions to “ SIMONE M SPENCER CNM” Practice Location

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