Provider Demographics
NPI:1740762111
Name:SPENCER, VANESSA NICHELLE (MED)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICHELLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 JEFFERSON ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-9457
Mailing Address - Country:US
Mailing Address - Phone:337-519-1011
Mailing Address - Fax:
Practice Address - Street 1:2519 JEFFERSON ISLAND RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-9457
Practice Address - Country:US
Practice Address - Phone:337-519-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator