Provider Demographics
NPI:1558019687
Name:SPURLOCK, JANELL ELLEN
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:ELLEN
Last Name:SPURLOCK
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 1:255 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1356
Mailing Address - Country:US
Mailing Address - Phone:720-937-2288
Mailing Address - Fax:
Practice Address - Street 1:255 FORREST DR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1356
Practice Address - Country:US
Practice Address - Phone:720-937-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263425163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management