Provider Demographics
NPI:1447901871
Name:SPRAGUE, NIKKIA LEIGH
Entity type:Individual
Prefix:
First Name:NIKKIA
Middle Name:LEIGH
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 WASHINGTON AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5723
Mailing Address - Country:US
Mailing Address - Phone:989-277-5194
Mailing Address - Fax:
Practice Address - Street 1:916 WASHINGTON AVE STE 325
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5723
Practice Address - Country:US
Practice Address - Phone:989-277-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily