Provider Demographics
NPI:1699268805
Name:CROSS, SPENCER (DNP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 CHARLEVOIX AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9701
Mailing Address - Country:US
Mailing Address - Phone:231-489-8151
Mailing Address - Fax:231-668-7794
Practice Address - Street 1:1114 CHARLEVOIX AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9701
Practice Address - Country:US
Practice Address - Phone:231-489-8151
Practice Address - Fax:231-668-7794
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299293363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner