Healthcare Provider Details

I. General information

NPI: 1366507345
Provider Name (Legal Business Name): BARBARA RUTH SPRUNG NPP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 REDFIELD DR
FARMINGTON NY
14425-8805
US

IV. Provider business mailing address

5975 REDFIELD DR
FARMINGTON NY
14425-8805
US

V. Phone/Fax

Practice location:
  • Phone: 315-538-8047
  • Fax: 315-538-8047
Mailing address:
  • Phone: 516-361-3313
  • Fax: 315-538-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: