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NPI Code Detail

MEDICARE: SHELI KAYE PARKISON

MEDICARE: SHELI KAYE PARKISON
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
1125J00000XDental TherapistDT72MN

General Provider Information

NPI Number : 1679033252
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELI KAYE PARKISON
Provider Business Mailing Address
First Line : 4243 4TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-2113
Country : US
Telephone Number : 612-822-9030
Fax Number :
Provider Business Practice Location Address
First Line : 4243 4TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-2113
Country : US
Telephone Number : 612-822-9030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 03/21/2019

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Directions to “ SHELI KAYE PARKISON ” Practice Location

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