Healthcare Provider Details

I. General information

NPI: 1730952136
Provider Name (Legal Business Name): DELETHIA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 R ST SE
WASHINGTON DC
20020-4624
US

IV. Provider business mailing address

2620 BOWEN RD SE
WASHINGTON DC
20020-6675
US

V. Phone/Fax

Practice location:
  • Phone: 202-725-3747
  • Fax:
Mailing address:
  • Phone: 202-549-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9099597
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number9099597
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: