Provider Demographics
NPI:1376638411
Name:SPARKS FREEMAN, VICKY L (MT ASPC CLS NCA)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:L
Last Name:SPARKS FREEMAN
Suffix:
Gender:F
Credentials:MT ASPC CLS NCA
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Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:TAOS PICURIS INDIAN HEALTH CENTER
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-4224
Mailing Address - Fax:505-751-5211
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:TAOS PICURIS INDIAN HEALTH CENTER
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-4224
Practice Address - Fax:505-751-5211
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist