Provider Demographics
NPI:1346591914
Name:SPRUNGER, MARIA JEAN (MSN,CNM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JEAN
Last Name:SPRUNGER
Suffix:
Gender:F
Credentials:MSN,CNM
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JEAN
Other - Last Name:CANELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,CNM
Mailing Address - Street 1:2200 JEFFERSON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 245
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7941
Practice Address - Country:US
Practice Address - Phone:270-538-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007695363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology