Provider Demographics
NPI:1407579741
Name:PLANTE, SPENCER GORDON (RN)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:GORDON
Last Name:PLANTE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-2504
Mailing Address - Country:US
Mailing Address - Phone:805-698-1681
Mailing Address - Fax:
Practice Address - Street 1:1086 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-2504
Practice Address - Country:US
Practice Address - Phone:805-698-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA767322163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health