Individual
SARA NICOLE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 UNIVERSITY ST, PELLA, IA 50219-1902
(877) 462-3687
Mailing address
202 W STEENHOEK ST UNIT B, PRAIRIE CITY, IA 50228-8812
(712) 210-5167
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
108741
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982665A
—
IA
Enumeration date
08/05/2019
Last updated
06/11/2021
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