Provider Demographics
NPI:1023835832
Name:SPRAGUE, KATIE (RM MSN MED)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:RM MSN MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 E CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-8305
Mailing Address - Country:US
Mailing Address - Phone:360-277-2302
Mailing Address - Fax:
Practice Address - Street 1:71 E CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8305
Practice Address - Country:US
Practice Address - Phone:360-277-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60017354163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool