MEDICARE: CHERYL ROSE PARKS CRNA

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	364S00000X	Clinical Nurse Specialist	RO68640	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00137653	OTHER	MD	MEDICARE RAILROAD (PTAN CJ8689)
2	P00687678	OTHER	MD	MEDICARE RAILROAD (PTAN DD6120)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	S417-0007	OTHER	DC	CAREFIRST BCBS
4	KBC1CH	OTHER	MD	CAREFIRST BCBS

General Provider Information

NPI Number	:	1902880222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ROSE PARKS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 790058
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0058
Country	:	US
Telephone Number	:	636-549-2380
Fax Number	:	314-569-5974

Provider Business Practice Location Address
First Line	:	45 THOMAS JOHNSON DR
Second Line	:	SUITE 207
City	:	FREDERICK
State	:	MD
Zip	:	21702-4425
Country	:	US
Telephone Number	:	301-694-3400
Fax Number	:	301-694-3620

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/17/2010

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Directions to “ CHERYL ROSE PARKS CRNA” Practice Location

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