Provider Demographics
NPI:1528195021
Name:SPENCER, STEPHANIE K (LMP, RNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMP, RNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 7TH AVE SE
Mailing Address - Street 2:D-215
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4063
Mailing Address - Country:US
Mailing Address - Phone:206-369-1484
Mailing Address - Fax:
Practice Address - Street 1:11030 7TH AVE SE
Practice Address - Street 2:D-215
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4063
Practice Address - Country:US
Practice Address - Phone:206-369-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA9511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist