Provider Demographics
NPI:1255782637
Name:SPENCE, ANNA KATE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KATE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:KATE
Other - Last Name:BERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:221 N 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08403-1507
Mailing Address - Country:US
Mailing Address - Phone:609-742-1530
Mailing Address - Fax:
Practice Address - Street 1:65 W JIMMIE LEEDS RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9102
Practice Address - Country:US
Practice Address - Phone:609-748-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00650500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered