Provider Demographics
NPI:1285158170
Name:SPENCER, GRACE ANNE (CRNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW STE 308
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1349
Mailing Address - Country:US
Mailing Address - Phone:205-787-2669
Mailing Address - Fax:205-787-2865
Practice Address - Street 1:817 PRINCETON AVE SW STE 308
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1349
Practice Address - Country:US
Practice Address - Phone:205-787-2669
Practice Address - Fax:205-787-2865
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty