Basic Information
Provider Information
NPI: 1366782609
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPRENGER
FirstName: WANDA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PMH-NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5010
Address2:  
City: MINOT
State: ND
PostalCode: 587015010
CountryCode: US
TelephoneNumber: 7018575650
FaxNumber: 7018575031
Practice Location
Address1: 407 3RD ST. S.E.
Address2:  
City: MINOT
State: ND
PostalCode: 587014470
CountryCode: US
TelephoneNumber: 7018572360
FaxNumber: 7018572187
Other Information
ProviderEnumerationDate: 02/24/2013
LastUpdateDate: 09/25/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XR21683NDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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