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General NPI Number Information
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NPI Number | 1528412624
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Entity Type | Individual
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Provider Name | STACEY R SPROULL ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 364 SE 8TH AVE STE 108A
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City | HILLSBORO
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State | OR
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Zip | 97123-4253
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Country | US
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Telephone | 503-494-8417
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Fax | 503-494-4455
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Provider Business Mailing Address
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Address Line | 364 SE 8TH AVE STE 108A
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City | HILLSBORO
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State | OR
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Zip | 97123-4253
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Country | US
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Telephone | 503-494-8417
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Fax | 503-494-4455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9165986
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61272607
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10018726
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License Number State | OR
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