Provider Demographics
NPI:1629350863
Name:SPENCER, LEONARD (RN)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27190 SHOREVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1543
Mailing Address - Country:US
Mailing Address - Phone:440-532-2271
Mailing Address - Fax:216-862-0809
Practice Address - Street 1:27190 SHOREVIEW AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1543
Practice Address - Country:US
Practice Address - Phone:440-532-2271
Practice Address - Fax:216-862-0809
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145479164W00000X
OHRN.424059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse