Provider Demographics
NPI:1912494642
Name:SPENCER, KAY (RN)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:SPENCER
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 1:3369 MILES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8707
Mailing Address - Country:US
Mailing Address - Phone:517-962-4861
Mailing Address - Fax:517-962-4596
Practice Address - Street 1:3369 MILES RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8707
Practice Address - Country:US
Practice Address - Phone:517-962-4861
Practice Address - Fax:517-962-4596
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse