Provider Demographics
NPI:1841612629
Name:SPRUILL, SHIRLEY NICOLE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:NICOLE
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 GOLDENEYE LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7596
Mailing Address - Country:US
Mailing Address - Phone:804-507-0070
Mailing Address - Fax:
Practice Address - Street 1:2905 GOLDENEYE LN
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-7596
Practice Address - Country:US
Practice Address - Phone:804-507-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide