Provider Demographics
NPI:1366857658
Name:HOLLINGSHEAD-PARKER, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HOLLINGSHEAD-PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 TIM BELL RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386
Mailing Address - Country:US
Mailing Address - Phone:209-401-3316
Mailing Address - Fax:877-638-7752
Practice Address - Street 1:421 TIM BELL RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CA
Practice Address - Zip Code:95386
Practice Address - Country:US
Practice Address - Phone:209-401-3316
Practice Address - Fax:877-638-7752
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse