Provider Demographics
NPI:1790265536
Name:SPELLER, PATRICIA WILLIAMS
Entity Type:Individual
Prefix:PROF
First Name:PATRICIA
Middle Name:WILLIAMS
Last Name:SPELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEMETRICE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:595 CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8560
Mailing Address - Country:US
Mailing Address - Phone:252-258-2502
Mailing Address - Fax:
Practice Address - Street 1:595 CLIFF CT
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8560
Practice Address - Country:US
Practice Address - Phone:252-258-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74000841253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$Other810735284