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NPI Code Detail

MEDICARE: MS. MAUREEN A SPRAGUE MS RD CDE

MEDICARE: MS. MAUREEN A SPRAGUE MS RD CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian705OR

General Provider Information

NPI Number : 1578654059
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAUREEN A SPRAGUE MS RD CDE
Provider Business Mailing Address
First Line : 1122 PROSPECT AVE
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-1529
Country : US
Telephone Number : 541-386-2976
Fax Number :
Provider Business Practice Location Address
First Line : 811 13TH ST
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-1204
Country : US
Telephone Number : 541-387-6133
Fax Number : 541-387-6348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/08/2007

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