MEDICARE: JOAN M SPENCER PCNS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN00363	RI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PNS00027	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30908-4	OTHER	RI	BLUE CROSS OF RI
2	413047	OTHER	RI	BLUE CHIP OF RI

General Provider Information

NPI Number	:	1760450753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN M SPENCER PCNS

Provider Business Mailing Address
First Line	:	70 KENYON AVE STE 326
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4239
Country	:	US
Telephone Number	:	401-788-1277
Fax Number	:	401-788-1514

Provider Business Practice Location Address
First Line	:	70 KENYON AVE
Second Line	:	326
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4239
Country	:	US
Telephone Number	:	401-788-1277
Fax Number	:	401-788-1514

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/19/2025

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