Provider Demographics
NPI:1063863108
Name:SPENCE, MARY (RN CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 TILLEY DR
Mailing Address - Street 2:ENDOCRINOLOGY
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4407
Mailing Address - Country:US
Mailing Address - Phone:802-847-5421
Mailing Address - Fax:802-847-2226
Practice Address - Street 1:62 TILLEY DR
Practice Address - Street 2:ENDOCRINOLOGY
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4407
Practice Address - Country:US
Practice Address - Phone:802-847-5421
Practice Address - Fax:802-847-2226
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0022256163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator