Provider Demographics
NPI:1891387858
Name:SPENCER, CHAD G (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:G
Last Name:SPENCER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 S ROCKET DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4935
Mailing Address - Country:US
Mailing Address - Phone:801-856-6414
Mailing Address - Fax:
Practice Address - Street 1:15215 S ROCKET DR
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-4935
Practice Address - Country:US
Practice Address - Phone:801-856-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF12200933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner