Provider Demographics
NPI:1346600772
Name:SPENCER, MARIE JULIE (CPNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JULIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SUNSET DR
Mailing Address - Street 2:SUITE B2
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5651
Mailing Address - Country:US
Mailing Address - Phone:831-636-8888
Mailing Address - Fax:831-636-8805
Practice Address - Street 1:890 SUNSET DR
Practice Address - Street 2:SUITE B2
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5651
Practice Address - Country:US
Practice Address - Phone:831-636-8888
Practice Address - Fax:831-636-8805
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476594363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics