Individual
SHELLY RENAE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 N MADISON AVE, ANDERSON, IN 46011-3453
(317) 621-4900
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71001150A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200357660
—
IN
Enumeration date
07/17/2006
Last updated
05/26/2021
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