Individual
LISA SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
2279G1100X
General Care Registered Respiratory Therapist
Primary
194006771
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194006771
NBRC
—
Enumeration date
09/13/2012
Last updated
09/13/2012
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