Provider Demographics
NPI:1720164593
Name:SPRAGUE, ROGER L (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:L
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 KINGS CROSSROADS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7323
Mailing Address - Country:US
Mailing Address - Phone:501-580-4548
Mailing Address - Fax:
Practice Address - Street 1:3956 KINGS CROSSROADS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7323
Practice Address - Country:US
Practice Address - Phone:501-580-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291022163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant