Healthcare Provider Details

I. General information

NPI: 1154329050
Provider Name (Legal Business Name): DONALD H PARKE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HAMLET AVE
HAMLET NC
28345-4522
US

IV. Provider business mailing address

1000 W HAMLET AVE
HAMLET NC
28345-4522
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-8909
  • Fax: 910-205-8952
Mailing address:
  • Phone: 910-205-8909
  • Fax: 910-205-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: