Provider Demographics
NPI:1578654059
Name:SPRAGUE, MAUREEN A (MS RD CDE)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:A
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1529
Mailing Address - Country:US
Mailing Address - Phone:541-386-2976
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1204
Practice Address - Country:US
Practice Address - Phone:541-387-6133
Practice Address - Fax:541-387-6348
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered