Provider Demographics
NPI:1245915503
Name:LEE-SPIVEY, ROSA MARIE
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIE
Last Name:LEE-SPIVEY
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 1:5008 INLAND LN APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2071
Mailing Address - Country:US
Mailing Address - Phone:304-926-7325
Mailing Address - Fax:
Practice Address - Street 1:5008 INLAND LN APT C
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-2071
Practice Address - Country:US
Practice Address - Phone:304-926-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant