Provider Demographics
NPI:1477938074
Name:PARKER, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name: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 1:19219 EUCLID AVE
Mailing Address - Street 2:B424
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1375
Mailing Address - Country:US
Mailing Address - Phone:216-302-5172
Mailing Address - Fax:
Practice Address - Street 1:19219 EUCLID AVE
Practice Address - Street 2:B424
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1375
Practice Address - Country:US
Practice Address - Phone:216-302-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155766164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse