Provider Demographics
NPI:1487006359
Name:SPENCER-KEMLER, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SPENCER-KEMLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 W WOOSTER ST RM 130
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2652
Mailing Address - Country:US
Mailing Address - Phone:419-352-6890
Mailing Address - Fax:
Practice Address - Street 1:806 N STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9708
Practice Address - Country:US
Practice Address - Phone:989-283-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490164Medicaid