Provider Demographics
NPI:1386140994
Name:SPENCE, NICOLE ELVEINA (LPN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELVEINA
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELVEINA
Other - Last Name:INNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:18 FOREST DR APT K
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-2125
Mailing Address - Country:US
Mailing Address - Phone:845-461-1555
Mailing Address - Fax:
Practice Address - Street 1:10 SCHRIEVER LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3314
Practice Address - Country:US
Practice Address - Phone:845-613-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292879164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse