Individual
STEPHANIE M SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 LAIDLEY ST, CHARLESTON, WV 25301-1614
(304) 344-0096
(304) 342-4725
Mailing address
PO BOX 1547, CAMC PROVIDER ENROLLMENT, CHARLESTON, WV 25326-1547
(304) 388-1724
(304) 388-1721
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN60156-CRNA
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006392
—
WV
01
—
8237761
MEDICARE PTAN
WV
Enumeration date
08/17/2006
Last updated
12/28/2018
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