Provider Demographics
NPI:1285869198
Name:SPENCER, NIKKI (LMT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2926
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2926
Mailing Address - Country:US
Mailing Address - Phone:808-937-3013
Mailing Address - Fax:
Practice Address - Street 1:64-1061 MAMALAHOA HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8482
Practice Address - Country:US
Practice Address - Phone:808-937-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT6087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist