Healthcare Provider Details

I. General information

NPI: 1801720719
Provider Name (Legal Business Name): ALLISON SPRUELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MORGAN THOME

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 LAPORTE AVE STE 8
VALPARAISO IN
46383-6997
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-1088
  • Fax: 219-464-7543
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28285951A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018376A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: