Provider Demographics
NPI:1710497961
Name:PARKER, CATHY LADORIS
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LADORIS
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 1:10414 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2937
Mailing Address - Country:US
Mailing Address - Phone:240-421-3776
Mailing Address - Fax:
Practice Address - Street 1:10414 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2937
Practice Address - Country:US
Practice Address - Phone:240-421-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00035868693747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003586869OtherAPPLYING FOR MEDICARE LICENSE