Provider Demographics
NPI:1124393103
Name:PARKER, QUIANA DOLLIE-MAE (RN)
Entity Type:Individual
Prefix:MS
First Name:QUIANA
Middle Name:DOLLIE-MAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MERAMEC AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1711
Mailing Address - Country:US
Mailing Address - Phone:314-615-0600
Mailing Address - Fax:314-615-8303
Practice Address - Street 1:4000 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3323
Practice Address - Country:US
Practice Address - Phone:314-679-7880
Practice Address - Fax:314-679-7876
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036281163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse