Provider Demographics
NPI:1508660283
Name:SPANN, NECHELLE
Entity type:Individual
Prefix:
First Name:NECHELLE
Middle Name:
Last Name:SPANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 KENILWORTH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6012
Mailing Address - Country:US
Mailing Address - Phone:330-727-0513
Mailing Address - Fax:
Practice Address - Street 1:158 KENILWORTH AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6012
Practice Address - Country:US
Practice Address - Phone:330-727-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health