Provider Demographics
NPI:1659180487
Name:SPENCER, MICHELLE MARIE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MEDBERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1221
Mailing Address - Country:US
Mailing Address - Phone:308-385-5775
Mailing Address - Fax:308-385-5780
Practice Address - Street 1:1506 23RD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-2236
Practice Address - Country:US
Practice Address - Phone:308-379-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion