Provider Demographics
NPI:1851530703
Name:SPARKS, MELANIE LYNN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LYNN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 OBSERVATION DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6419
Mailing Address - Country:US
Mailing Address - Phone:301-525-7904
Mailing Address - Fax:
Practice Address - Street 1:20410 OBSERVATION DR
Practice Address - Street 2:STE 100
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6419
Practice Address - Country:US
Practice Address - Phone:301-400-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195287363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care