Provider Demographics
NPI:1891128526
Name:SPENCER, KETRINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:KETRINA
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 HARBIN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4325
Mailing Address - Country:US
Mailing Address - Phone:419-787-3913
Mailing Address - Fax:
Practice Address - Street 1:5433 HARBIN CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4325
Practice Address - Country:US
Practice Address - Phone:419-787-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.12197-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse