Individual
MRS. LORETTA MARGARET SPARKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
313 W COUNTRY CLUB RD, SUITE 5, ROSWELL, NM 88201-5804
(866) 559-8607
(866) 559-8607
Mailing address
PO BOX 571, ROSWELL, NM 88202-0571
(866) 559-8607
(866) 559-8607
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP-02005
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000575565
—
NM
01
—
46-2684908
FEIN
NM
01
—
NMA102670
MEDICARE NUMBER
NM
Enumeration date
02/10/2012
Last updated
05/23/2013
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