Individual
MARISSA DANIELLE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5401 LEDGESTONE DR, FORT WORTH, TX 76132-2344
(405) 816-6010
Mailing address
5401 LEDGESTONE DR, FORT WORTH, TX 76132-2344
(405) 816-6010
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
725519
TX
Other
Enumeration date
01/28/2011
Last updated
01/27/2014
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