Provider Demographics
NPI:1639803877
Name:HASKELL, SPARKEL
Entity Type:Individual
Prefix:
First Name:SPARKEL
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 EBY AVE # 201
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1638
Mailing Address - Country:US
Mailing Address - Phone:913-563-8216
Mailing Address - Fax:
Practice Address - Street 1:7225 EBY AVE # 201
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1638
Practice Address - Country:US
Practice Address - Phone:913-563-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS88-3093344374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty