Healthcare Provider Details

I. General information

NPI: 1184838443
Provider Name (Legal Business Name): CONNIE PARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 LOGAN WAY
HUBBARD OH
44425-3345
US

IV. Provider business mailing address

4504 LOGAN WAY
HUBBARD OH
44425-3345
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8334
  • Fax: 330-759-0780
Mailing address:
  • Phone: 330-759-8334
  • Fax: 330-759-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN ZOCCO
Title or Position: VICE PRESIDENT
Credential:
Phone: 330-759-8334