Provider Demographics
NPI:1992887566
Name:SPRAGUE, KAREN (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 CONQUISTADOR WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6722
Mailing Address - Country:US
Mailing Address - Phone:916-753-7123
Mailing Address - Fax:
Practice Address - Street 1:131 W A ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3437
Practice Address - Country:US
Practice Address - Phone:707-635-1600
Practice Address - Fax:707-635-1641
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner