Provider Demographics
NPI:1649916511
Name:SPELL, ANDREA NICOLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:SPELL
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 1:22945 E IL HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BLUFORD
Mailing Address - State:IL
Mailing Address - Zip Code:62814-4015
Mailing Address - Country:US
Mailing Address - Phone:618-417-5297
Mailing Address - Fax:
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE RIVE
Practice Address - State:IL
Practice Address - Zip Code:62810-1228
Practice Address - Country:US
Practice Address - Phone:618-316-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider