Provider Demographics
NPI:1326638941
Name:SPENCER, DARYZUA EMERALD
Entity Type:Individual
Prefix:
First Name:DARYZUA
Middle Name:EMERALD
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2031
Mailing Address - Country:US
Mailing Address - Phone:304-421-3647
Mailing Address - Fax:
Practice Address - Street 1:535 WYOMING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2031
Practice Address - Country:US
Practice Address - Phone:304-421-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant