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NPI Code Detail

MEDICARE: NICOLE MARIE SPENCER MD

MEDICARE: NICOLE MARIE SPENCER MD
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
1207V00000XObstetrics & Gynecology PhysicianT7051TX
2207VX0201XGynecologic Oncology Physician80221MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21760973176OTHERTXCSHCN

General Provider Information

NPI Number : 1760973176
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE SPENCER MD
Provider Business Mailing Address
First Line : 2550 UNIVERSITY AVE W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1052
Country : US
Telephone Number : 651-602-5335
Fax Number :
Provider Business Practice Location Address
First Line : 11850 BLACKFOOT ST NW STE 100
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2774
Country : US
Telephone Number : 763-712-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2018
Last Update Date : 08/18/2025

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