Provider Demographics
NPI:1154840007
Name:SPENCER, BERNADETTE EILEEN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:EILEEN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:NORTH JAVA
Mailing Address - State:NY
Mailing Address - Zip Code:14113-0129
Mailing Address - Country:US
Mailing Address - Phone:716-710-2450
Mailing Address - Fax:716-320-8485
Practice Address - Street 1:4027 SODOM RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:NY
Practice Address - Zip Code:14066-9731
Practice Address - Country:US
Practice Address - Phone:716-319-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily