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NPI Code Detail

MEDICARE: MRS. CARRIE SPENCER RN

MEDICARE: MRS. CARRIE SPENCER RN
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 Nurse200963-3102UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200963-3102OTHERUTRN

General Provider Information

NPI Number : 1942392857
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARRIE SPENCER RN
Provider Business Mailing Address
First Line : 94 W 385 N
Second Line :
City : HYDE PARK
State : UT
Zip : 84318-4026
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 90 E 200 N
Second Line :
City : LOGAN
State : UT
Zip : 84321-4034
Country : US
Telephone Number : 435-752-0750
Fax Number : 435-752-7433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CARRIE SPENCER RN” Practice Location

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