MEDICARE: LINDY JO SPRAGUE NP-C

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	163W00000X	Registered Nurse	4704268643	MI
2	363L00000X	Nurse Practitioner	4704268643	MI
3	363LF0000X	Family Nurse Practitioner	4704268643	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720597685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDY JO SPRAGUE NP-C

Provider Business Mailing Address
First Line	:	5900 BYRON CENTER AVE SW
Second Line	:	MEDICAL ADMINISTRATION
City	:	WYOMING
State	:	MI
Zip	:	49519-9606
Country	:	US
Telephone Number	:	616-252-3243
Fax Number	:	616-252-0260

Provider Business Practice Location Address
First Line	:	3912 32ND AVE
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426
Country	:	US
Telephone Number	:	616-252-8700
Fax Number	:	616-252-8750

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

Provider Enumeration Date	:	09/23/2017
Last Update Date	:	01/30/2026

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