Provider Demographics
NPI:1992154959
Name:SPENCER, SHAWANDA LESTER (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHAWANDA
Middle Name:LESTER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 YELLOWHORN TRL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7465
Mailing Address - Country:US
Mailing Address - Phone:704-907-0537
Mailing Address - Fax:888-375-9322
Practice Address - Street 1:12830 WALKER BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8850
Practice Address - Country:US
Practice Address - Phone:704-583-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008617363LF0000X
NCF0516317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5008617OtherNC BOARD OF NURSING APPROVAL NUMBER
NCF0516317OtherAANP CERTIFICATION