Basic Information
| Provider Information | |||||||||
| NPI: | 1275084550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCE | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSN, RN, AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176055 | ||||||||
| FaxNumber: | 7172174329 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 SCOTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176055 | ||||||||
| FaxNumber: | 7172174329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN562648 | PA | N | Nursing Service Providers | Registered Nurse | 363LG0600X | SP016790 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 1007307260070 | 01 | PA | DHS GROUP # | OTHER | 867633 | 01 | PA | NOVITAS (MEDICARE) GROUP # | OTHER | 103246571 | 05 | PA | MEDICAID |