Provider Demographics
NPI:1184436776
Name:SPARKS, CHARLINE RAE
Entity type:Individual
Prefix:
First Name:CHARLINE
Middle Name:RAE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CRESTWOOD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-7214
Mailing Address - Country:US
Mailing Address - Phone:402-640-6079
Mailing Address - Fax:
Practice Address - Street 1:117 CRESTWOOD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7214
Practice Address - Country:US
Practice Address - Phone:402-640-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider