Provider Demographics
NPI:1679166870
Name:SPENCER, MINNIE
Entity type:Individual
Prefix:
First Name:MINNIE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1924
Mailing Address - Country:US
Mailing Address - Phone:304-872-6383
Mailing Address - Fax:
Practice Address - Street 1:212 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1924
Practice Address - Country:US
Practice Address - Phone:304-872-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker