Provider Demographics
NPI:1285445254
Name:SPARKS, ROWENA DANIELL
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:DANIELL
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S CLOVERDALE BLVD UNIT 313
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-4052
Mailing Address - Country:US
Mailing Address - Phone:707-867-6906
Mailing Address - Fax:
Practice Address - Street 1:520 S CLOVERDALE BLVD UNIT 313
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-4052
Practice Address - Country:US
Practice Address - Phone:707-867-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula