Provider Demographics
NPI:1639994940
Name:SPRUELL, JACOB RYAN
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:SPRUELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BROAD ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4812
Mailing Address - Country:US
Mailing Address - Phone:804-276-6059
Mailing Address - Fax:
Practice Address - Street 1:2501 TURNER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23224-2537
Practice Address - Country:US
Practice Address - Phone:804-276-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator