Provider Demographics
NPI:1083753156
Name:SPENCER, ELIOT (CRNA, MSN)
Entity Type:Individual
Prefix:MR
First Name:ELIOT
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 490
Mailing Address - Street 2:BOX 9006
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-9386
Mailing Address - Fax:
Practice Address - Street 1:BLDG #1 FARENHOLT RD
Practice Address - Street 2:U.S. NAVAL HOSPITAL GUAM
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-344-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83256163W00000X
SC4390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse