Provider Demographics
NPI:1902273501
Name:SPARKS, ANNEMARIE (BS ED)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:BS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PARKVILLE STATION ROAD
Mailing Address - Street 2:PMB 133
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1621
Mailing Address - Country:US
Mailing Address - Phone:609-670-8152
Mailing Address - Fax:856-494-1495
Practice Address - Street 1:176 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5155
Practice Address - Country:US
Practice Address - Phone:609-670-8152
Practice Address - Fax:856-494-1495
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator