Healthcare Provider Details

I. General information

NPI: 1952431611
Provider Name (Legal Business Name): NANCY SHARON PARKINSON MS RD CD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 NORTH WHEELING AVENUE
MUNCIE IN
47304-5264
US

IV. Provider business mailing address

3636 N LAKESIDE DRIVE
MUNCIE IN
47304-5264
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-6197
  • Fax: 765-282-1901
Mailing address:
  • Phone: 765-254-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001648A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD5863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: