Individual provider Active NPI

Sally L Sprowl Eagar, RN-C

  • Psychiatric/Mental Health Registered Nurse
  • Augusta, ME
National Provider Identifier
1649461583
Registry record updated Aug 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
R036740 Issued in ME
Practice address
66 Stone St
Augusta, ME 04330-5227
Phone
(207) 626-3455
Fax
(207) 626-3612
NPI assigned
Aug 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X R036740 ME Primary

Addresses

Primary practice location

66 Stone St
Augusta, ME 04330-5227

Mailing address

66 Stone St
Augusta, ME 04330-5227
Phone (207) 626-3455

Other names 1

  • Sally L Fuller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
R036740MEMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Kennebec Valley Mental Health Center PastSince Nov 6, 2000 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186358400000",
    "number": "1649461583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 STONE ST",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043305227",
            "telephone_number": "207-626-3455",
            "fax_number": "207-626-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 STONE ST",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043305227",
            "telephone_number": "207-626-3455",
            "fax_number": "207-626-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPROWL EAGAR",
        "first_name": "SALLY",
        "middle_name": "L",
        "credential": "RN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "ME",
            "license": "R036740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "FULLER",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Augusta, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.