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General NPI Number Information
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NPI Number | 1619310380
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Entity Type | Individual
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Provider Name | CAROL DIANE PARKS CT, CLT
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Gender | Female
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 8565 MENTOR AVE.
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-974-7966
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Fax |
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Provider Business Mailing Address
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Address Line | 8787 BILLINGS RD.
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City | KIRTLAND
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State | OH
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Zip | 44094
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Country | US
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Telephone | 440-974-7966
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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 | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State |
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