Basic Information
| Provider Information | |||||||||
| NPI: | 1003151820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPANGLER | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | ROWE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 WESTOVER AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271042113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368301052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5838 SIX FORKS RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276093885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192779841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-03559 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.