Provider Demographics
NPI:1568870566
Name:KLEITSCH, SPENCER KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:KAY
Last Name:KLEITSCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0148
Mailing Address - Country:US
Mailing Address - Phone:563-578-3275
Mailing Address - Fax:563-578-3279
Practice Address - Street 1:1753 W RIDGEWAY AVE STE 111
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-833-5970
Practice Address - Fax:319-833-5971
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA130599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15689OtherWELLMARK BCBS
IA0076372Medicaid