Healthcare Provider Details

I. General information

NPI: 1881775765
Provider Name (Legal Business Name): SANDRA GAIL PARKS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 WICKFORD RD
CLEVELAND OH
44112-1208
US

IV. Provider business mailing address

1716 WICKFORD RD
CLEVELAND OH
44112-1208
US

V. Phone/Fax

Practice location:
  • Phone: 216-486-7678
  • Fax:
Mailing address:
  • Phone: 216-486-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number326613
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: