Individual
TIFFANY SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4170 16TH ST, ECORSE, MI 48229-1239
(248) 930-3374
Mailing address
4170 16TH ST, ECORSE, MI 48229-1239
(248) 930-3374
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110615
MI
Other
Enumeration date
04/16/2018
Last updated
04/16/2018
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