Provider Demographics
NPI:1225356520
Name:PARKS, ANGELIA RENEA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:RENEA
Last Name:PARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ANGELIA
Other - Middle Name:RENEA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6601 MORRY CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3639
Mailing Address - Country:US
Mailing Address - Phone:937-272-0397
Mailing Address - Fax:
Practice Address - Street 1:6601 MORRY CT
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3639
Practice Address - Country:US
Practice Address - Phone:937-272-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128284164W00000X
OH399346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse