Provider Demographics
NPI:1730756438
Name:GLASPELL, ALEXUS
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:
Last Name:GLASPELL
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 1:428 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2723
Mailing Address - Country:US
Mailing Address - Phone:304-657-4612
Mailing Address - Fax:
Practice Address - Street 1:428 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2723
Practice Address - Country:US
Practice Address - Phone:304-657-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV753258Medicaid