Provider Demographics
NPI:1174979652
Name:SPRAGUE, AMY LOUISE (DNP, RN, ACNS-BC, CC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:DNP, RN, ACNS-BC, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 E LORETTA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7766
Mailing Address - Country:US
Mailing Address - Phone:317-788-6774
Mailing Address - Fax:
Practice Address - Street 1:3460 E LORETTA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7766
Practice Address - Country:US
Practice Address - Phone:317-788-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28128545A163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine