Provider Demographics
NPI:1902211261
Name:SPENCER, LORI ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1110
Mailing Address - Country:US
Mailing Address - Phone:315-536-4429
Mailing Address - Fax:315-536-4352
Practice Address - Street 1:305 COURT ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1110
Practice Address - Country:US
Practice Address - Phone:315-536-4429
Practice Address - Fax:315-536-4352
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33955-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program