Spencer, Mary Jo L
Spencer, Mary Jo L is an individual health care provider with primary practice located at 516 Delaware St Se Pwb Fourth Floor, Room 4-100, Minneapolis MN 55455-0356. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Spencer, Mary Jo L can be contacted via phone (612) 884-0936.Contact Information
Primary practice address
516 Delaware St Se Pwb Fourth Floor, Room 4-100
Minneapolis MN 55455-0356
Phone: (612) 884-0936
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | R 086024-0 | Minnesota |
Profile Details
| NPI number | 1881794659 |
|---|---|
| LBN Legal business name | Spencer, Mary Jo L |
| Credentials | Certified Pediatric Nurse Practitioner (CPNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 22nd, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881794659 | NPPES |
| Minnesota | Other | 12-13453 | MEDICA CHOICE |
| Minnesota | Other | HP20941 | MEDICA CHOICE |
| Minnesota | Other | 05G59SP | MEDICA CHOICE |
| Minnesota | Other | 768359 | MEDICA CHOICE |
| Minnesota | Other | 107868 | MEDICA CHOICE |
| Minnesota | Other | 12-13453 | MEDICA CHOICE |
| Minnesota | MEDICAID | 4300179 | MEDICA CHOICE |
| Minnesota | MEDICAID | 131017800 | MEDICA CHOICE |
| Minnesota | Other | 1015967 | MEDICA CHOICE |
| Minnesota | Other | 157941 | MEDICA CHOICE |
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