Provider Demographics
NPI:1114461993
Name:SPENCER, DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9662
Mailing Address - Country:US
Mailing Address - Phone:413-219-5226
Mailing Address - Fax:
Practice Address - Street 1:8 ATWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4266
Practice Address - Country:US
Practice Address - Phone:413-773-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN52321164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse