Provider Demographics
NPI:1598359051
Name:SPENCER, BARBARA NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:NICHOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19487 N 1050TH ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:IL
Mailing Address - Zip Code:62432-2205
Mailing Address - Country:US
Mailing Address - Phone:618-562-7388
Mailing Address - Fax:
Practice Address - Street 1:19487 N 1050TH ST
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:IL
Practice Address - Zip Code:62432-2205
Practice Address - Country:US
Practice Address - Phone:618-562-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine