Provider Demographics
NPI:1922774363
Name:SPENCER, GABRIELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
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 1:156 ECCLES AVE
Mailing Address - Street 2:
Mailing Address - City:HAGAMAN
Mailing Address - State:NY
Mailing Address - Zip Code:12086-7728
Mailing Address - Country:US
Mailing Address - Phone:518-956-0193
Mailing Address - Fax:
Practice Address - Street 1:4950 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-841-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348007-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care