Provider Demographics
NPI:1487657052
Name:SPENCER, NANCY LYNN (MSN FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19643 SW BERNHARDT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:503-494-9000
Mailing Address - Fax:503-494-0018
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 740
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6634
Practice Address - Country:US
Practice Address - Phone:503-297-7403
Practice Address - Fax:503-297-3096
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-10-02
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2007-10-02
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275173Medicaid