Provider Demographics
NPI:1821137936
Name:MILLER SPENCER, CHARMAINE RENA (NPC)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:RENA
Last Name:MILLER SPENCER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N BALFOUR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104
Mailing Address - Country:US
Mailing Address - Phone:972-291-9611
Mailing Address - Fax:
Practice Address - Street 1:9202 ELAM RD
Practice Address - Street 2:#350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217
Practice Address - Country:US
Practice Address - Phone:214-266-1719
Practice Address - Fax:214-266-1732
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255137363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health