MEDICARE: SHANICE 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	374J00000X	Doula

General Provider Information

NPI Number	:	1912854142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE PARKER

Provider Business Mailing Address
First Line	:	1110 SAINT BARTHOLOMEW DR
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-1413
Country	:	US
Telephone Number	:	618-750-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	6608 W MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-3026
Country	:	US
Telephone Number	:	618-750-3851
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ SHANICE PARKER ” Practice Location

Language	Start Address	Practice Location

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