Provider Demographics
NPI:1134999410
Name:SPENCER, DEREC DEVON
Entity type:Individual
Prefix:
First Name:DEREC
Middle Name:DEVON
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 P ST SW APT 404
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2938
Mailing Address - Country:US
Mailing Address - Phone:202-643-5029
Mailing Address - Fax:
Practice Address - Street 1:325 P ST SW APT 404
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2938
Practice Address - Country:US
Practice Address - Phone:202-643-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide