Provider Demographics
NPI:1124429477
Name:SPENCER, TARESA A (LPN)
Entity type:Individual
Prefix:MRS
First Name:TARESA
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TARESA
Other - Middle Name:A
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 S. 336TH ST. SUITE 210
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:866-835-8091
Mailing Address - Fax:888-835-7102
Practice Address - Street 1:1010 S. 336TH ST. SUITE 210
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:866-835-8091
Practice Address - Fax:888-835-7102
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60126073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse