Healthcare Provider Details

I. General information

NPI: 1326017369
Provider Name (Legal Business Name): STEPHANIE A. SPARKS-THOMPSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 N 58TH ST
MILWAUKEE WI
53218-4249
US

IV. Provider business mailing address

5009 N 58TH ST
MILWAUKEE WI
53218-4249
US

V. Phone/Fax

Practice location:
  • Phone: 414-763-0188
  • Fax:
Mailing address:
  • Phone: 414-763-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number32485-031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: