Provider Demographics
NPI:1457992778
Name:SPRAGUE, VICKIE J
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:J
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 S CHARLTON PARK RD LOT 24
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-9125
Mailing Address - Country:US
Mailing Address - Phone:269-953-4393
Mailing Address - Fax:
Practice Address - Street 1:2905 S CHARLTON PARK RD LOT 24
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9125
Practice Address - Country:US
Practice Address - Phone:269-953-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care