MEDICARE: DANITRA MICHELL PARKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1194366427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANITRA MICHELL PARKER

Provider Business Mailing Address
First Line	:	4955 JEFFREYS ST UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2284
Country	:	US
Telephone Number	:	818-245-2964
Fax Number	:

Provider Business Practice Location Address
First Line	:	4955 JEFFREYS ST UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2284
Country	:	US
Telephone Number	:	818-245-2964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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Directions to “ DANITRA MICHELL PARKER ” Practice Location

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