Provider Demographics
NPI:1073947792
Name:SPENCE, CEYON PETRINA (RN)
Entity Type:Individual
Prefix:
First Name:CEYON
Middle Name:PETRINA
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 PENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3917
Mailing Address - Country:US
Mailing Address - Phone:661-309-8644
Mailing Address - Fax:
Practice Address - Street 1:6957 PENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3917
Practice Address - Country:US
Practice Address - Phone:661-309-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA841156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse