Individual
MR. BRENT ALAN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1421 N 7TH ST, TERRE HAUTE, IN 47807-1005
(812) 231-4608
(812) 231-4675
Mailing address
4215 CARRIAGE LN, TERRE HAUTE, IN 47805-8628
(812) 239-2707
(812) 231-4675
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28115785A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200344100 A
—
IN
Enumeration date
06/26/2006
Last updated
07/23/2015
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