Provider Demographics
NPI:1093172017
Name:SPROAT, MARIE (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SPROAT
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-1313
Mailing Address - Country:US
Mailing Address - Phone:202-340-9859
Mailing Address - Fax:
Practice Address - Street 1:921B LEJEUNE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5916
Practice Address - Country:US
Practice Address - Phone:910-463-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-82781174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN