Provider Demographics
NPI:1790074565
Name:SPICER, STEPHANIE LEAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEAH
Last Name:SPICER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6495
Mailing Address - Country:US
Mailing Address - Phone:315-349-5300
Mailing Address - Fax:
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6495
Practice Address - Country:US
Practice Address - Phone:315-349-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse