Provider Demographics
NPI:1083268718
Name:SPENCE, BRIAN (MSW, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SPENCE
Suffix:
Gender:M
Credentials:MSW, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 DETROIT AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2741
Mailing Address - Country:US
Mailing Address - Phone:419-357-5088
Mailing Address - Fax:
Practice Address - Street 1:636 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1306
Practice Address - Country:US
Practice Address - Phone:216-432-7200
Practice Address - Fax:330-787-9505
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025278363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health