Provider Demographics
NPI:1396097069
Name:SPENCER, KRISTIN LYNN (CNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CNP
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Other - Credentials:
Mailing Address - Street 1:3007 HARBOR LANE NORTH
Mailing Address - Street 2:PARK NICOLLET CLINIC PLYMOUTH - FAMILY MEDICINE
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447
Mailing Address - Country:US
Mailing Address - Phone:952-993-8900
Mailing Address - Fax:952-993-8955
Practice Address - Street 1:3007 HARBOR LANE NORTH
Practice Address - Street 2:PARK NICOLLET CLINIC PLYMOUTH - FAMILY MEDICINE
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:952-993-8900
Practice Address - Fax:952-993-8955
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR121426-4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily