Organization
ADVANCED PRACTICE ADULT-GERONTOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL K SPENCER MSN,AGPCP,BC (OWNER)
(276) 768-9058
Entity
Organization
Contact information
Practice address
5140 HATCHER RD, FAIRVIEW HOME, DUBLIN, VA 24084-4802
(276) 431-4200
Mailing address
121 PINEY VIEW LN, MOUTH OF WILSON, VA 24363-3694
(276) 768-9058
(276) 783-2879
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
0017142291
VA
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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