Provider Demographics
NPI:1972808491
Name:SPENCER, COLETTE CRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:CRISTINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 HOLMAN ROAD NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-524-0033
Mailing Address - Fax:206-524-0035
Practice Address - Street 1:9776 HOLMAN ROAD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-524-0033
Practice Address - Fax:206-524-0035
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60109880163W00000X, 163WP0808X, 163WP0809X
WAAP60326660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult