Provider Demographics
NPI:1083840144
Name:SPENCE, ROSALYN DOROTHY
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:DOROTHY
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 UNION AVE
Mailing Address - Street 2:APT 4D
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3664
Mailing Address - Country:US
Mailing Address - Phone:914-665-4410
Mailing Address - Fax:
Practice Address - Street 1:204 UNION AVE
Practice Address - Street 2:APT 4D
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3664
Practice Address - Country:US
Practice Address - Phone:914-665-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse