Provider Demographics
NPI:1093215618
Name:SPENCER, MICK A
Entity Type:Individual
Prefix:
First Name:MICK
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 GRANT DR STE L
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5350
Mailing Address - Country:US
Mailing Address - Phone:775-348-0827
Mailing Address - Fax:
Practice Address - Street 1:3680 GRANT DR STE L
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5350
Practice Address - Country:US
Practice Address - Phone:775-348-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker