Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209.016058 | IL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209.016058 | IL |
NPI | 1386164879 |
---|---|
Provider Name | Jamee Sprague |
First Address | Hoopeston, IL 60942-1904 |
Second Address | Hoopeston, IL 60942-1904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209.016058 | ADVANCED PRACTICE NURSE LICENSE (01) | IL |