Provider Demographics
NPI:1134453319
Name:SPARKS, SUNNY NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:NICOLE
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 1:195 WEDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1927
Mailing Address - Country:US
Mailing Address - Phone:513-520-2322
Mailing Address - Fax:
Practice Address - Street 1:195 WEDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1927
Practice Address - Country:US
Practice Address - Phone:513-520-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.121073-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse