Healthcare Provider Details

I. General information

NPI: 1982343943
Provider Name (Legal Business Name): NICHOLAS SPARKS DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

3200 SYCAMORE CT STE 1B
COLUMBUS IN
47203-1545
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-4938
  • Fax:
Mailing address:
  • Phone: 812-378-9027
  • Fax: 812-378-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28230169A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: