Provider Demographics
NPI:1003190646
Name:SPENCER, SUZETTE MARIE (ND)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:MARIE
Other - Last Name:MAILLOUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:3550 AIRPORT WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4772
Mailing Address - Country:US
Mailing Address - Phone:907-479-2331
Mailing Address - Fax:866-834-0164
Practice Address - Street 1:3550 AIRPORT WAY STE 4
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4772
Practice Address - Country:US
Practice Address - Phone:907-479-2331
Practice Address - Fax:866-834-0164
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK83175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath