Provider Demographics
NPI:1275770315
Name:SPENCER, AMY E (CNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-7942
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1711 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-8772
Practice Address - Fax:740-354-2138
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2968543Medicaid