Provider Demographics
NPI:1932199080
Name:SPENCER, MELANIE LINN (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LINN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LINN
Other - Last Name:WHITEHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2605 NORTHRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4065
Mailing Address - Country:US
Mailing Address - Phone:515-292-4845
Mailing Address - Fax:515-303-2291
Practice Address - Street 1:2605 NORTHRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4065
Practice Address - Country:US
Practice Address - Phone:515-292-4845
Practice Address - Fax:515-303-2291
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29352OtherWMC-BCBS ER
IA0424507Medicaid
IA0293522Medicaid
IA0655001Medicaid
IA33444OtherWMC FPC-BCBS
IA66046OtherWMC BCBS SNF
IA0635011Medicaid
IA0283465Medicaid
IA0600460Medicaid
IA36174OtherWMC-BCBS DME
IA60046OtherWMC BCBS
IACE8231Medicare Oscar/Certification
IA0293522Medicaid
IA0600460Medicaid
IA33444OtherWMC FPC-BCBS
IA161302Medicare Oscar/Certification