Provider Demographics
NPI:1700657087
Name:SPENCER, REBECCA LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1556 64TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNDON STATION
Mailing Address - State:WI
Mailing Address - Zip Code:53944-9335
Mailing Address - Country:US
Mailing Address - Phone:608-217-1245
Mailing Address - Fax:
Practice Address - Street 1:W1556 64TH ST
Practice Address - Street 2:
Practice Address - City:LYNDON STATION
Practice Address - State:WI
Practice Address - Zip Code:53944-9335
Practice Address - Country:US
Practice Address - Phone:608-217-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15306-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily