Provider Demographics
NPI:1699650549
Name:SPENCER, SUSAN A (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:MACAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6166 DOWNS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6550
Mailing Address - Country:US
Mailing Address - Phone:410-914-8765
Mailing Address - Fax:
Practice Address - Street 1:6166 DOWNS RIDGE CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6550
Practice Address - Country:US
Practice Address - Phone:443-889-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW261768913104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances