Provider Demographics
NPI:1013798826
Name:SPROUTS HEALTH CLINIC INC
Entity Type:Organization
Organization Name:SPROUTS HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:KALUBA
Authorized Official - Last Name:SSOZI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:857-417-5688
Mailing Address - Street 1:24 WARREN AVE # AVA
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3043
Mailing Address - Country:US
Mailing Address - Phone:857-417-5688
Mailing Address - Fax:
Practice Address - Street 1:300 BAKER AVE # 300A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2131
Practice Address - Country:US
Practice Address - Phone:857-417-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty