Healthcare Provider Details

I. General information

NPI: 1255930699
Provider Name (Legal Business Name): LIANE PARKER RN CPHM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 CINWOOD ST NW
MASSILLON OH
44646-5114
US

IV. Provider business mailing address

4035 CINWOOD ST NW
MASSILLON OH
44646-5114
US

V. Phone/Fax

Practice location:
  • Phone: 740-994-1811
  • Fax: 740-888-0306
Mailing address:
  • Phone: 740-994-1811
  • Fax: 740-888-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.465068
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number242276
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242276
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: