Provider Demographics
NPI:1447512520
Name:SPRAGUE, MARY ELIZABETH (RN)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELIZABETH
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18108 STEAMER WAY
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5244
Mailing Address - Country:US
Mailing Address - Phone:228-249-9532
Mailing Address - Fax:
Practice Address - Street 1:18108 STEAMER WAY
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5244
Practice Address - Country:US
Practice Address - Phone:228-249-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse