Provider Demographics
NPI:1093314643
Name:PARKS, ROBIN RENEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:RENEE
Last Name:PARKS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7970 20 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9494
Mailing Address - Country:US
Mailing Address - Phone:616-821-2826
Mailing Address - Fax:616-913-2037
Practice Address - Street 1:4150 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3605
Practice Address - Country:US
Practice Address - Phone:616-913-2006
Practice Address - Fax:616-913-2037
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206982163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health