Provider Demographics
NPI:1174849871
Name:SPRAWL, HATTIE RENEE
Entity Type:Individual
Prefix:
First Name:HATTIE
Middle Name:RENEE
Last Name:SPRAWL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239
Mailing Address - Country:US
Mailing Address - Phone:513-931-0609
Mailing Address - Fax:
Practice Address - Street 1:6604 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4715
Practice Address - Country:US
Practice Address - Phone:513-931-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117310164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN117310OtherNURSING LICENSE