Provider Demographics
NPI:1063620185
Name:SPENST, TERRIE LYNNE (RNNP)
Entity type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:LYNNE
Last Name:SPENST
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 WOOLSEY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9648
Mailing Address - Country:US
Mailing Address - Phone:707-321-0063
Mailing Address - Fax:707-528-8700
Practice Address - Street 1:11 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6615
Practice Address - Country:US
Practice Address - Phone:707-542-8700
Practice Address - Fax:707-528-8700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner