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General NPI Number Information
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NPI Number | 1356169908
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Entity Type | Individual
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Provider Name | RONALD PARKER NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1066 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3113
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Country | US
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Telephone | 734-240-4870
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Fax | 734-682-5083
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Provider Business Mailing Address
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Address Line | 114 N MAUMEE ST
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City | TECUMSEH
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State | MI
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Zip | 49286-1529
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Country | US
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Telephone | 517-260-3409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704315501
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License Number State | MI
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