Provider Demographics
NPI:1558872473
Name:PARKER, MAKABI DORIS (RN, BSN, PHN, MBA)
Entity Type:Individual
Prefix:MRS
First Name:MAKABI
Middle Name:DORIS
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, BSN, PHN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16155 SIERRA LAKES PKWY STE 160-508
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1244
Mailing Address - Country:US
Mailing Address - Phone:909-584-3522
Mailing Address - Fax:
Practice Address - Street 1:18245 EVENING PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-0481
Practice Address - Country:US
Practice Address - Phone:909-584-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732337163WA2000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse