=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477328730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLENA JOHANNA CHANCE SPRUILL CD (DONA)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2023
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3917 NANTUCKET RD UNIT B
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-291-0710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4220 BOSTIC DR APT 201
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-9446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-291-0710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number | 15066
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------