Provider Demographics
NPI:1154329050
Name:PARKE, DONALD H (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:PARKE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W HAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4522
Mailing Address - Country:US
Mailing Address - Phone:910-205-8909
Mailing Address - Fax:910-205-8952
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:910-205-8909
Practice Address - Fax:910-205-8952
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104318367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050663Medicaid
NC8050663Medicaid