Individual
MARY JO L SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
516 DELAWARE ST SE, PWB FOURTH FLOOR, ROOM 4-100, MINNEAPOLIS, MN 55455-0356
(612) 884-0936
Mailing address
420 DELAWARE STREET SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 884-0936
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R 086024-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05G59SP
BLUE CROSS BLUE SHIELD
MN
01
—
1015967
PREFERRED ONE
MN
01
—
107868
UCARE
MN
01
—
12-13453
MEDICA CHOICE
MN
05
—
131017800
—
MN
01
—
157941
FAIRVIEW
MN
05
—
4300179
—
MT
01
—
768359
ARAZ
MN
01
—
HP20941
HEALTH PARTNERS
MN
Enumeration date
09/22/2006
Last updated
07/08/2007
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