Individual
TERAH ANN SPROULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
71001115A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235990
ANTHEM PROVIDER NUMBER
IN
05
—
200336300
—
IN
01
—
9397651
PHCS PID NUMBER
IN
Enumeration date
03/23/2006
Last updated
02/24/2021
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