Basic Information
| Provider Information | |||||||||
| NPI: | 1316339930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCE | ||||||||
| FirstName: | SUZARIE | ||||||||
| MiddleName: | VAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHN-BAPTISTE | ||||||||
| OtherFirstName: | SUZARIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 OCEANGATE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908024317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624996191 | ||||||||
| FaxNumber: | 5614996171 | ||||||||
| Practice Location | |||||||||
| Address1: | 6339 MACK RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958234655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165857912 | ||||||||
| FaxNumber: | 8774797101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2015 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95001965 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | EFF: 6/14/16 - NORWO | 05 | CA | MEDICAID | EFF: 6/14/16- 55TH | 05 | CA | MEDICAID | EFF: 6/14/16 - MACK | 05 | CA | MEDICAID | EFF: 6/14/16 - MARYS | 05 | CA | MEDICAID | EFF: 6/14/16 C H | 05 | CA | MEDICAID |