Healthcare Provider Details

I. General information

NPI: 1760616221
Provider Name (Legal Business Name): CAROLYN L PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2599 ROMIG RD APT 48
AKRON OH
44320-3864
US

IV. Provider business mailing address

2599 ROMIG RD APT 48
AKRON OH
44320-3864
US

V. Phone/Fax

Practice location:
  • Phone: 330-745-6237
  • Fax: 330-745-6237
Mailing address:
  • Phone: 330-745-6237
  • Fax: 330-745-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRF830868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: