Provider Demographics
NPI:1770122020
Name:SPRAGUE, REBECCA (MS, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1899
Mailing Address - Country:US
Mailing Address - Phone:207-284-5953
Mailing Address - Fax:
Practice Address - Street 1:329 NORTH ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1899
Practice Address - Country:US
Practice Address - Phone:207-284-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered