Basic Information
| Provider Information | |||||||||
| NPI: | 1952312217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARKS | ||||||||
| FirstName: | DEAN | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14402 E SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099222625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16760 N HIGHWAY 41 | ||||||||
| Address2: | |||||||||
| City: | RATHDRUM | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838588715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086875627 | ||||||||
| FaxNumber: | 8448073782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA16890 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA60599094 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.