Provider Demographics
NPI:1770574113
Name:SPENCER-CISEK, PATRICIA (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SPENCER-CISEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-6545
Mailing Address - Fax:518-926-1954
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-926-6545
Practice Address - Fax:518-926-1954
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02328738Medicaid
NY080174918OtherRR MEDICARE
NY080174918OtherRR MEDICARE
NY02328738Medicaid