MEDICARE: MRS. COLLEEN KAY SPENCER RN, BSN

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	163WH0200X	Home Health Registered Nurse	77124-030	WI

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	:	1730355645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN KAY SPENCER RN, BSN

Provider Business Mailing Address
First Line	:	185 EDGEWOOD RD N
Second Line	:
City	:	CUSTER
State	:	WI
Zip	:	54423-9780
Country	:	US
Telephone Number	:	715-592-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 EDGEWOOD RD N
Second Line	:
City	:	CUSTER
State	:	WI
Zip	:	54423-9780
Country	:	US
Telephone Number	:	715-592-4092
Fax Number	:

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	10/08/2008

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