MEDICARE: CINDY ANN SPARKS R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	RN201094	OH

General Provider Information

NPI Number	:	1457527822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY ANN SPARKS R.N.

Provider Business Mailing Address
First Line	:	19353 BAGLEY RD
Second Line	:	B304
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3319
Country	:	US
Telephone Number	:	440-239-8101
Fax Number	:	440-239-8101

Provider Business Practice Location Address
First Line	:	19353 BAGLEY RD
Second Line	:	B304
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3319
Country	:	US
Telephone Number	:	440-239-8101
Fax Number	:	440-239-8101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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