Provider Demographics
NPI:1972164259
Name:SPENCER, BRITTENY
Entity Type:Individual
Prefix:
First Name:BRITTENY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 TOWN AND FOUR PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6227
Mailing Address - Country:US
Mailing Address - Phone:314-566-5299
Mailing Address - Fax:
Practice Address - Street 1:1122 TOWN AND FOUR PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6227
Practice Address - Country:US
Practice Address - Phone:314-566-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide