Provider Demographics
NPI:1780578641
Name:SPENCER, JAIME MARIE (RN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:MARIE
Other - Last Name:KRANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1780 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2268
Mailing Address - Country:US
Mailing Address - Phone:763-516-4297
Mailing Address - Fax:
Practice Address - Street 1:4570 VICTORIA ST N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5800
Practice Address - Country:US
Practice Address - Phone:651-621-6000
Practice Address - Fax:651-621-6046
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2529677163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse