Provider Demographics
NPI:1730786757
Name:SPICER, PHILIP JAMES (APRN)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:SPICER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2657
Mailing Address - Country:US
Mailing Address - Phone:937-668-5718
Mailing Address - Fax:
Practice Address - Street 1:1896 AMYS RIDGE CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-7192
Practice Address - Country:US
Practice Address - Phone:937-282-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily