Healthcare Provider Details

I. General information

NPI: 1942821244
Provider Name (Legal Business Name): NICOLE SPORRER DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SHORT ST NW
CEDAR RAPIDS IA
52405-4294
US

IV. Provider business mailing address

881 SHADETREE CT
LISBON IA
52253-9691
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-7115
  • Fax: 319-396-7388
Mailing address:
  • Phone: 515-720-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number138753
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01210525
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: