Provider Demographics
NPI:1821859547
Name:SPENCE, VANNESSA O (SERVICE PROVIDER)
Entity Type:Individual
Prefix:
First Name:VANNESSA
Middle Name:O
Last Name:SPENCE
Suffix:
Gender:F
Credentials:SERVICE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 5TH AVE APT A402
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7076
Mailing Address - Country:US
Mailing Address - Phone:509-792-6527
Mailing Address - Fax:
Practice Address - Street 1:1000 W 5TH AVE APT A402
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7076
Practice Address - Country:US
Practice Address - Phone:509-792-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide