Provider Demographics
NPI:1790449387
Name:SPENCER, TONYA YVETTE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:YVETTE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KENILWORTH AVE NE APT 232
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1522
Mailing Address - Country:US
Mailing Address - Phone:202-910-4434
Mailing Address - Fax:
Practice Address - Street 1:1517 BENNING RD NE APT J12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8512
Practice Address - Country:US
Practice Address - Phone:202-869-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant