Provider Demographics
NPI:1659825347
Name:SPARKS, DOROTHEA 'JEANA' (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:'JEANA'
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DOROTHEA
Other - Middle Name:JEANA
Other - Last Name:SAPRKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3145 W TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3411
Mailing Address - Country:US
Mailing Address - Phone:513-614-3445
Mailing Address - Fax:
Practice Address - Street 1:3145 W TOWER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3411
Practice Address - Country:US
Practice Address - Phone:513-614-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114516 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse