Provider Demographics
NPI:1922428713
Name:SPARKS, ERICA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1943
Mailing Address - Country:US
Mailing Address - Phone:513-312-4781
Mailing Address - Fax:
Practice Address - Street 1:169 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-312-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse