Provider Demographics
NPI:1912499971
Name:SPENCER, LUCINDA M (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-3228
Mailing Address - Country:US
Mailing Address - Phone:618-283-3144
Mailing Address - Fax:618-283-3194
Practice Address - Street 1:1510 SUNSET DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-3228
Practice Address - Country:US
Practice Address - Phone:618-283-3144
Practice Address - Fax:618-283-3194
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily