Provider Demographics
NPI:1427276674
Name:SPRAGUE, WINOLA S (CNS)
Entity type:Individual
Prefix:DR
First Name:WINOLA
Middle Name:S
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:DR
Other - First Name:WINOLA
Other - Middle Name:S
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP-CNS-BC
Mailing Address - Street 1:520 N. CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266
Mailing Address - Country:US
Mailing Address - Phone:330-296-5552
Mailing Address - Fax:330-296-1310
Practice Address - Street 1:520 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2218
Practice Address - Country:US
Practice Address - Phone:330-296-5552
Practice Address - Fax:330-296-1310
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10275364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2923135Medicaid
OH2923135Medicaid