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NPI Code Detail

MEDICARE: LUANNE PARKS NP

MEDICARE: LUANNE PARKS NP
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
1363LF0000XFamily Nurse Practitioner4704160005MI
2363LP0808XPsychiatric/Mental Health Nurse Practitioner4704160005MI

General Provider Information

NPI Number : 1851313878
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUANNE PARKS NP
Provider Business Mailing Address
First Line : 2198 US 31 S
Second Line :
City : MANISTEE
State : MI
Zip : 49660-9618
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2198 US 31 S
Second Line :
City : MANISTEE
State : MI
Zip : 49660-9618
Country : US
Telephone Number : 231-655-3146
Fax Number : 231-723-1735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 01/09/2025

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