Provider Demographics
NPI:1326527391
Name:SPARKS CORGAN, LORI ANN (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:SPARKS CORGAN
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 1:14256 W CORA LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8480
Mailing Address - Country:US
Mailing Address - Phone:623-535-9055
Mailing Address - Fax:
Practice Address - Street 1:14256 W CORA LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8480
Practice Address - Country:US
Practice Address - Phone:623-535-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN097241163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management