Healthcare Provider Details

I. General information

NPI: 1982929022
Provider Name (Legal Business Name): MS. AIMEE ELIZABETH SPRAGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 NW BROADWAY
PORTLAND OR
97209-3580
US

IV. Provider business mailing address

232 NW 6TH AVE
PORTLAND OR
97209-3609
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-7134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201504649NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: