Mary Jo L Spencer, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R 086024-0 Issued in MN

Practice address

516 Delaware St SE
PWB Fourth Floor, Room 4-100
Minneapolis, MN 55455-0356

Phone

(612) 884-0936

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cardiothoracic Surgery Clinic of North Ms

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Tupelo, MS
  • NPI 1154533321
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881794659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE",
            "address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-884-0936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 DELAWARE ST SE",
            "address_2": "PWB FOURTH FLOOR, ROOM 4-100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550356",
            "telephone_number": "612-884-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "MARY JO",
        "middle_name": "L",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R 086024-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "12-13453",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP20941",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05G59SP",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "768359",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "107868",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "12-13453",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4300179",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131017800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1015967",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAIRVIEW",
            "identifier": "157941",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Spencer, DDS
• Celina Spencer
• Dahlela Spencer
• Katherine G Spencer, PHD
• Maria Spencer
• Mary K Spencer, RD, LD, CDE
• Julie Spengler
• Julie A Spenner, PHARMD
• Anne M Spenningsby, PHARMD, MPH
• Dana Christine Spensley, LICSW

• Pediatric Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.