Healthcare Provider Details

I. General information

NPI: 1114594918
Provider Name (Legal Business Name): DANIELLE NICOLE PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MEADOWVIEW DR
PERU IN
46970-8996
US

IV. Provider business mailing address

1552 STRAWTOWN PIKE
PERU IN
46970-2773
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-8049
  • Fax: 765-475-8895
Mailing address:
  • Phone: 765-472-8049
  • Fax: 765-475-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number28189228A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28189228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: