Provider Demographics
NPI:1962709550
Name:SPENCER, JANE KELSEY (ACNS)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:KELSEY
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1072 N LIBERTY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-2800
Practice Address - Country:US
Practice Address - Phone:208-367-4035
Practice Address - Fax:208-367-7111
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-56A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health