Provider Demographics
NPI:1336857507
Name:SPARLIN, JENA LOUISE (LVN)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:LOUISE
Last Name:SPARLIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28065 STATE HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9673
Mailing Address - Country:US
Mailing Address - Phone:530-524-1426
Mailing Address - Fax:
Practice Address - Street 1:28065 STATE HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9673
Practice Address - Country:US
Practice Address - Phone:530-524-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN683958164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse