Provider Demographics
NPI:1558718833
Name:PARKER, SHAYE CHANELL (LPN)
Entity Type:Individual
Prefix:
First Name:SHAYE
Middle Name:CHANELL
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W FOXRUN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9340
Mailing Address - Country:US
Mailing Address - Phone:419-494-5094
Mailing Address - Fax:
Practice Address - Street 1:89 W FOXRUN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9340
Practice Address - Country:US
Practice Address - Phone:419-494-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150303164W00000X
MI4703112687164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse