Provider Demographics
NPI:1487731253
Name:SAMUEL, NECHELLE LAVETTE (AGENCY DIRECTOR)
Entity type:Individual
Prefix:MISS
First Name:NECHELLE
Middle Name:LAVETTE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:AGENCY DIRECTOR
Other - Prefix:MISS
Other - First Name:NECHELLE
Other - Middle Name:LAVETTE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGENCY DIRECTOR
Mailing Address - Street 1:1001 S MARSHALL ST STE 20
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5852
Mailing Address - Country:US
Mailing Address - Phone:336-624-5604
Mailing Address - Fax:
Practice Address - Street 1:1001 S MARSHALL ST STE 20
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-624-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3039251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health