Provider Demographics
NPI:1417645193
Name:STODDARD, SPENCER ELI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:ELI
Last Name:STODDARD
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 Y ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1745
Mailing Address - Country:US
Mailing Address - Phone:435-669-3088
Mailing Address - Fax:402-476-6809
Practice Address - Street 1:8550 CUTHILLS CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9474
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:402-476-6809
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10455165-4405363LP0808X
NE115307363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health