Provider Demographics
NPI:1538952304
Name:SPELL, WANDA DENISE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:DENISE
Last Name:SPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1711 CROSSROADS VISTA DR APT 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4191
Mailing Address - Country:US
Mailing Address - Phone:919-539-3420
Mailing Address - Fax:919-539-3420
Practice Address - Street 1:1711 CROSSROADS VISTA DR APT 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-4191
Practice Address - Country:US
Practice Address - Phone:919-539-3420
Practice Address - Fax:919-539-3420
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker