Provider Demographics
NPI:1760450753
Name:SPENCER, JOAN M (PCNS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SUITE 326
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4239
Mailing Address - Country:US
Mailing Address - Phone:401-788-1277
Mailing Address - Fax:401-788-1514
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:326
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-788-1277
Practice Address - Fax:401-788-1514
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPNS00027363LP0808X
RIAPRN00363363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30908-4OtherBLUE CROSS OF RI
RI413047OtherBLUE CHIP OF RI
RIQ19380Medicare UPIN
RI413047OtherBLUE CHIP OF RI