Provider Demographics
NPI:1821059742
Name:SPENCER, NANCY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3277
Practice Address - Fax:518-262-4210
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF331793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02054539Medicaid
NY02054539Medicaid
NYDD6411Medicare PIN
NYRB6293Medicare PIN