Provider Demographics
NPI:1457851248
Name:PARKS, LANA LADELL (RN)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:LADELL
Last Name:PARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5408
Mailing Address - Country:US
Mailing Address - Phone:903-454-1413
Mailing Address - Fax:
Practice Address - Street 1:3445 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5411
Practice Address - Country:US
Practice Address - Phone:903-453-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse