Provider Demographics
NPI:1942242920
Name:SPRAGUE, DIANNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3855
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:1401 CREES ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1029
Practice Address - Country:US
Practice Address - Phone:319-627-2131
Practice Address - Fax:319-627-2087
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P47348Medicare UPIN
IAI12812Medicare PIN