Provider Demographics
NPI:1760082622
Name:PARKS, SAMARA MONIQUE
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:MONIQUE
Last Name:PARKS
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 1:6559 PLAINFIELD RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1927
Mailing Address - Country:US
Mailing Address - Phone:513-952-3017
Mailing Address - Fax:
Practice Address - Street 1:6559 PLAINFIELD RD APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-1927
Practice Address - Country:US
Practice Address - Phone:513-952-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty