Provider Demographics
NPI:1669231015
Name:PEARSON, SPENCER L (PA-C)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LITTLE PINE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:MN
Mailing Address - Zip Code:55032-3509
Mailing Address - Country:US
Mailing Address - Phone:608-449-4931
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1899
Practice Address - Country:US
Practice Address - Phone:320-225-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical