MEDICARE: WYNETTA PARKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063908127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYNETTA PARKER

Provider Business Mailing Address
First Line	:	3100 E 45TH ST STE 314
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1095
Country	:	US
Telephone Number	:	216-441-9622
Fax Number	:	888-460-4717

Provider Business Practice Location Address
First Line	:	4368 E 143RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2310
Country	:	US
Telephone Number	:	216-860-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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Directions to “ WYNETTA PARKER ” Practice Location

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