Provider Demographics
NPI:1215114814
Name:SPENCE, TRACEY BRANDIN (LPN 1)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:BRANDIN
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LPN 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 7118
Mailing Address - Street 2:RED RIVER ADDICTIONS COMPLEX
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0118
Mailing Address - Country:US
Mailing Address - Phone:318-484-6400
Mailing Address - Fax:318-487-5703
Practice Address - Street 1:242 WEST SHAMROCK ST
Practice Address - Street 2:UNIT 6 MEADOW LANE
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-0118
Practice Address - Country:US
Practice Address - Phone:318-484-6400
Practice Address - Fax:318-487-5703
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA280068164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse