Provider Demographics
NPI:1881862464
Name:PARKER, TERRI L (RN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9465
Mailing Address - Country:US
Mailing Address - Phone:231-276-9363
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY STE 200
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9651
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-882-2360
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704179343OtherSTATE OF MICHIGAN LICENSE