Healthcare Provider Details

I. General information

NPI: 1356403802
Provider Name (Legal Business Name): SARA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SENECA HEALTH SERVICES INC 804 BROAD STREET
SUMMERSVILLE WV
26651
US

IV. Provider business mailing address

SENECA HEALTH SERVICES INC 1305 WEBSTER ROAD
SUMMERSVILLE WV
26651
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2090
  • Fax: 304-872-3590
Mailing address:
  • Phone: 304-872-6577
  • Fax: 304-872-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60383
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: