Provider Demographics
NPI:1700643715
Name:SPENCE, SHAVONNE (RN)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 W. 97TH AVE
Mailing Address - Street 2:4
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031
Mailing Address - Country:US
Mailing Address - Phone:817-941-1197
Mailing Address - Fax:
Practice Address - Street 1:2949 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3741
Practice Address - Country:US
Practice Address - Phone:817-941-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11521612083B0002X, 251J00000X, 171400000X, 364SF0001X, 374J00000X, 405300000X, 163WG0000X, 133N00000X, 163WE0003X, 163WL0100X, 163WX1100X, 163WM0102X
CO261QH0100X, 332900000X
TX18025156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332900000XSuppliersNon-Pharmacy Dispensing Site
No171400000XOther Service ProvidersHealth & Wellness Coach
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No374J00000XNursing Service Related ProvidersDoula
No405300000XOther Service ProvidersPrevention Professional
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmic
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn