Provider Demographics
NPI:1801858402
Name:SPENCER, SHARON L (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 2ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1519
Mailing Address - Country:US
Mailing Address - Phone:402-336-2900
Mailing Address - Fax:
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1519
Practice Address - Country:US
Practice Address - Phone:402-336-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110093363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110093OtherNEBRASKA STATE LICENSE NUMBER
NE10025621600Medicaid
NEP00626224Medicare PIN
NE10025621600Medicaid
NENA1943007Medicare PIN