Healthcare Provider Details

I. General information

NPI: 1568149714
Provider Name (Legal Business Name): CARRIE SPANGLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 US ROUTE 60 STE A
ONA WV
25545-9507
US

IV. Provider business mailing address

3198 US ROUTE 60 STE A
ONA WV
25545-9507
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-9430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70271
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: