Provider Demographics
NPI:1154114585
Name:SPENCER, EVETTA M
Entity type:Individual
Prefix:
First Name:EVETTA
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 GRANT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1872
Mailing Address - Country:US
Mailing Address - Phone:202-768-3116
Mailing Address - Fax:
Practice Address - Street 1:4609 E CAPITOL ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5240
Practice Address - Country:US
Practice Address - Phone:202-361-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1337271OtherLISENCE