Provider Demographics
NPI:1568007052
Name:CAREY, SPARKLE (LPN)
Entity Type:Individual
Prefix:
First Name:SPARKLE
Middle Name:
Last Name:CAREY
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 1:16235 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-7303
Mailing Address - Country:US
Mailing Address - Phone:440-452-5637
Mailing Address - Fax:440-306-9017
Practice Address - Street 1:2428 ELYRIA AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1366
Practice Address - Country:US
Practice Address - Phone:440-787-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.167467.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse