Provider Demographics
NPI:1346421567
Name:SPARKS, ROSALYN DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:DENISE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14375 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1747
Mailing Address - Country:US
Mailing Address - Phone:216-253-4746
Mailing Address - Fax:
Practice Address - Street 1:14375 SUPERIOR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1747
Practice Address - Country:US
Practice Address - Phone:216-253-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH118604164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse