Provider Demographics
NPI:1689972614
Name:COUNTRY NURSES, INC.
Entity Type:Organization
Organization Name:COUNTRY NURSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-674-6642
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1150
Mailing Address - Country:US
Mailing Address - Phone:920-674-6642
Mailing Address - Fax:920-674-6872
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1150
Practice Address - Country:US
Practice Address - Phone:920-674-6642
Practice Address - Fax:920-674-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care