Provider Demographics
NPI:1558391961
Name:PARKER, LAURIE J
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
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 1:300 TWINING STREET
Mailing Address - Street 2:
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-5143
Mailing Address - Fax:315-953-8296
Practice Address - Street 1:455 WELONA CREEK RD
Practice Address - Street 2:
Practice Address - City:TITUS
Practice Address - State:AL
Practice Address - Zip Code:36080-4245
Practice Address - Country:US
Practice Address - Phone:334-868-1958
Practice Address - Fax:315-953-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN3068053163WC1500X
CA5036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health