Provider Demographics
NPI:1245886209
Name:SPRAGUE, MELISA SUZANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:SUZANNE
Last Name:SPRAGUE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:SUZANNE
Other - Last Name:BERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5553
Mailing Address - Country:US
Mailing Address - Phone:207-333-4799
Mailing Address - Fax:207-333-4767
Practice Address - Street 1:330 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5553
Practice Address - Country:US
Practice Address - Phone:207-333-4799
Practice Address - Fax:207-333-4767
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2037363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant