MEDICARE: ALMANETTA NIKON PARKER LPN

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	164W00000X	Licensed Practical Nurse	LPN.155732.MEDS-IV	OH

General Provider Information

NPI Number	:	1558141531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALMANETTA NIKON PARKER LPN

Provider Business Mailing Address
First Line	:	14700 BRUNSWICK AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3818
Country	:	US
Telephone Number	:	216-760-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 BRUNSWICK AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3818
Country	:	US
Telephone Number	:	216-760-5077
Fax Number	:

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

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	11/17/2023

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