Provider Demographics
NPI:1689615775
Name:SPENCER, ELSIE M (FNP)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:M
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 1:306 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4346
Mailing Address - Country:US
Mailing Address - Phone:252-247-2013
Mailing Address - Fax:
Practice Address - Street 1:306 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4346
Practice Address - Country:US
Practice Address - Phone:252-247-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003764Medicaid
NCP03345Medicare UPIN
NC7003764Medicaid