Healthcare Provider Details

I. General information

NPI: 1104735299
Provider Name (Legal Business Name): LANI VISITACION PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 64 NE
NEW SALISBURY IN
47161-8432
US

IV. Provider business mailing address

1279 HIGHWAY 64 NE
NEW SALISBURY IN
47161-8432
US

V. Phone/Fax

Practice location:
  • Phone: 812-736-0708
  • Fax:
Mailing address:
  • Phone: 812-736-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1610099417
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: