Provider Demographics
NPI:1164164307
Name:PARKER, GARY DEVALLEN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DEVALLEN
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3102
Mailing Address - Country:US
Mailing Address - Phone:440-323-4658
Mailing Address - Fax:
Practice Address - Street 1:116 BELL AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3102
Practice Address - Country:US
Practice Address - Phone:440-323-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide