Provider Demographics
NPI:1962101204
Name:SPENCER, SONYA RENE (FNP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:RENE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 E BALD EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5714
Mailing Address - Country:US
Mailing Address - Phone:804-687-9575
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-768-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5485482-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily