Healthcare Provider Details

I. General information

NPI: 1316333560
Provider Name (Legal Business Name): ANGELINA ROSE SPREWELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR STE 3500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

2018 CLINCH AVE
KNOXVILLE TN
37916-2301
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax: 304-691-1375
Mailing address:
  • Phone: 865-898-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018-00561
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4217
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: