MEDICARE: MRS. LILA ALLISON PARKER RN

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	163W00000X	Registered Nurse	R68270	AR

General Provider Information

NPI Number	:	1417143470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILA ALLISON PARKER RN

Provider Business Mailing Address
First Line	:	2801 TIMBERMIST DR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-4790
Country	:	US
Telephone Number	:	501-776-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 TIMBERMIST DR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-4790
Country	:	US
Telephone Number	:	501-776-1632
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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