Provider Demographics
NPI:1053339739
Name:SPENCER, LINDA JANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JANE
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 1:69 E GARNER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7000
Mailing Address - Country:US
Mailing Address - Phone:317-852-3616
Mailing Address - Fax:317-298-3851
Practice Address - Street 1:69 E GARNER RD STE 300
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7000
Practice Address - Country:US
Practice Address - Phone:317-852-3616
Practice Address - Fax:317-852-6969
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200249390Medicaid
IN2202240AMedicare ID - Type Unspecified
IN200249390Medicaid
INP00211637Medicare PIN