Provider Demographics
NPI:1831388511
Name:SPELL, GLORIA SHANELE DIANE (CNA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:SHANELE DIANE
Last Name:SPELL
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 1:1245 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3841
Mailing Address - Country:US
Mailing Address - Phone:704-928-5043
Mailing Address - Fax:
Practice Address - Street 1:1245 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3841
Practice Address - Country:US
Practice Address - Phone:704-928-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC280311376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide