Provider Demographics
NPI:1477761096
Name:PARKER, CONNIE JEAN (ARRT)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:JEAN
Last Name:PARKER
Suffix:
Gender:F
Credentials:ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 TISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IL
Mailing Address - Zip Code:61087-9740
Mailing Address - Country:US
Mailing Address - Phone:815-908-1314
Mailing Address - Fax:
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-328-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093212471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology