Provider Demographics
NPI:1275004574
Name:PARKER, NADJA R (LPN)
Entity Type:Individual
Prefix:
First Name:NADJA
Middle Name:R
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W LIDO PROMENADE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6612
Mailing Address - Country:US
Mailing Address - Phone:347-954-7966
Mailing Address - Fax:
Practice Address - Street 1:95 W LIDO PROMENADE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6612
Practice Address - Country:US
Practice Address - Phone:347-954-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-12
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331901-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse