Provider Demographics
NPI:1508820374
Name:SPRAGUE, LAURALEE MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURALEE
Middle Name:MARIE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11159 ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-9618
Mailing Address - Country:US
Mailing Address - Phone:716-532-1580
Mailing Address - Fax:716-532-8787
Practice Address - Street 1:100 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-532-8799
Practice Address - Fax:716-532-8787
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426002197OtherFIDELIS
NY02341591Medicaid
9512209OtherIHA
00027791901OtherUNIVERA
000560712003OtherBC/BS
NY00347544Medicaid
060317000060OtherFIDELIS
NYP66220Medicare UPIN
NY00347544Medicaid
RA1693Medicare PIN
NYDD2121Medicare ID - Type Unspecified