Healthcare Provider Details

I. General information

NPI: 1972904860
Provider Name (Legal Business Name): THE PARKER SKIN & AESTHETIC CLININ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 PARK EAST DR SUITE 104
BEACHWOOD OH
44122-4338
US

IV. Provider business mailing address

3733 PARK EAST DR SUITE 104
BEACHWOOD OH
44122-4338
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-7333
  • Fax: 216-464-2696
Mailing address:
  • Phone: 216-464-7333
  • Fax: 216-464-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16492-NP
License Number StateOH

VIII. Authorized Official

Name: DR. LYDIA PARKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-464-7333