=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699410738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSTANCE S SPRATT LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 05/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16236 N LAKE ST
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93638-1615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-691-4488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2609 HOLIDAY WAY
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-416-0428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | VN221099
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | VN221099
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------