Provider Demographics
NPI:1467058198
Name:SPIRES, ANNETTE CLAUDINE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CLAUDINE
Last Name:SPIRES
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 1:1640 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-8128
Mailing Address - Country:US
Mailing Address - Phone:937-205-0066
Mailing Address - Fax:
Practice Address - Street 1:1640 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-8128
Practice Address - Country:US
Practice Address - Phone:937-205-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide