MEDICARE: MR. ROGER L. SPRAGUE CSA

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	163WR0006X	Registered Nurse First Assistant	291022	NC

General Provider Information

NPI Number	:	1720164593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER L. SPRAGUE CSA

Provider Business Mailing Address
First Line	:	3956 KINGS CROSSROADS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-7323
Country	:	US
Telephone Number	:	501-580-4548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3956 KINGS CROSSROADS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-7323
Country	:	US
Telephone Number	:	501-580-4548
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	09/05/2023

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