Provider Demographics
NPI:1861084436
Name:SPROW, KERRIE A (LPN)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:A
Last Name:SPROW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BIEDE AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2497
Mailing Address - Country:US
Mailing Address - Phone:419-782-8856
Mailing Address - Fax:
Practice Address - Street 1:211 BIEDE AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2497
Practice Address - Country:US
Practice Address - Phone:419-782-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN086481MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse