Provider Demographics
NPI:1790814143
Name:SPARREVOHN, CARRIE REEDTZ (LM)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:REEDTZ
Last Name:SPARREVOHN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:REEDTZ
Other - Last Name:SPARREVOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM
Mailing Address - Street 1:10950 BACHELOR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WITTER SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95493-9734
Mailing Address - Country:US
Mailing Address - Phone:530-304-3417
Mailing Address - Fax:
Practice Address - Street 1:10950 BACHELOR VALLEY RD
Practice Address - Street 2:
Practice Address - City:WITTER SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95493-9734
Practice Address - Country:US
Practice Address - Phone:530-304-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM25176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife