MEDICARE: CONSTANCE S SPRATT LVN

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
1	164W00000X	Licensed Practical Nurse	VN221099	CA
2	164X00000X	Licensed Vocational Nurse	VN221099	CA

General Provider Information

NPI Number	:	1699410738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE S SPRATT LVN

Provider Business Mailing Address
First Line	:	2609 HOLIDAY WAY
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-4124
Country	:	US
Telephone Number	:	559-416-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	16236 N LAKE ST
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93638-1615
Country	:	US
Telephone Number	:	559-691-4488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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Directions to “ CONSTANCE S SPRATT LVN” Practice Location

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