Provider Demographics
NPI:1093397408
Name:SPARKS, RHONDA J (RN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:J
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5343
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-5343
Mailing Address - Country:US
Mailing Address - Phone:575-799-2288
Mailing Address - Fax:
Practice Address - Street 1:2513 PUTNAM DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9349
Practice Address - Country:US
Practice Address - Phone:575-799-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR20621163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse