Provider Demographics
NPI:1639340219
Name:SPARKS, HELEN GRACE (LPN)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:GRACE
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 1:57 SALINA ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9402
Mailing Address - Country:US
Mailing Address - Phone:315-635-2704
Mailing Address - Fax:315-635-2768
Practice Address - Street 1:57 SALINA ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9402
Practice Address - Country:US
Practice Address - Phone:315-635-2704
Practice Address - Fax:315-635-2768
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279697-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse