Provider Demographics
NPI:1609170547
Name:PARKER, SHOLONDA L
Entity Type:Individual
Prefix:MRS
First Name:SHOLONDA
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHOLONDA
Other - Middle Name:L
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8729 S LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3420
Mailing Address - Country:US
Mailing Address - Phone:773-429-9021
Mailing Address - Fax:
Practice Address - Street 1:8729 S LOOMIS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3420
Practice Address - Country:US
Practice Address - Phone:773-429-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle