Provider Demographics
NPI:1942821244
Name:SPORRER, NICOLE (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SPORRER
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 SHADETREE CT
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9691
Mailing Address - Country:US
Mailing Address - Phone:515-720-3207
Mailing Address - Fax:
Practice Address - Street 1:75 SHORT ST NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4294
Practice Address - Country:US
Practice Address - Phone:319-396-7115
Practice Address - Fax:319-396-7388
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA138753163WN0800X
IAF01210525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience