Provider Demographics
NPI:1629764758
Name:SPENCER, MELISSA COOMBS (PA-S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:COOMBS
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3226
Mailing Address - Country:US
Mailing Address - Phone:303-842-6476
Mailing Address - Fax:
Practice Address - Street 1:1729 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3226
Practice Address - Country:US
Practice Address - Phone:303-842-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program