Provider Demographics
NPI:1972229284
Name:SPENCER, TAMMY (CNA/MSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CNA/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 S HYDRAULIC ST LOT 148
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-3166
Mailing Address - Country:US
Mailing Address - Phone:316-371-7284
Mailing Address - Fax:
Practice Address - Street 1:5135 S HYDRAULIC ST LOT 148
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-3166
Practice Address - Country:US
Practice Address - Phone:131-637-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide