Provider Demographics
NPI:1275084550
Name:SPENCE, LORI A (MSN, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MSN, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-217-6055
Mailing Address - Fax:717-217-4329
Practice Address - Street 1:2055 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1451
Practice Address - Country:US
Practice Address - Phone:717-217-6055
Practice Address - Fax:717-217-4329
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN562648163W00000X
PASP016790363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260070OtherDHS GROUP #
PA867633OtherNOVITAS (MEDICARE) GROUP #
PA103246571Medicaid