Provider Demographics
NPI:1174167126
Name:SPENCER, ASHLEIGH (LPN)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2351
Mailing Address - Country:US
Mailing Address - Phone:315-760-1202
Mailing Address - Fax:
Practice Address - Street 1:316 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2351
Practice Address - Country:US
Practice Address - Phone:315-760-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335915164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse