Basic Information
| Provider Information | |||||||||
| NPI: | 1356673255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCE | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7650 SW BEVELAND RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036013615 | ||||||||
| FaxNumber: | 5036461683 | ||||||||
| Practice Location | |||||||||
| Address1: | 1003 N PROVIDENCE DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971327521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035382698 | ||||||||
| FaxNumber: | 5035549328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD163392 | OR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | R231360 | 01 | OR | MEDICARE | OTHER | R231361 | 01 | OR | MEDICARE | OTHER | 500660241 | 05 | OR | MEDICAID |