Provider Demographics
NPI:1942802780
Name:PARKER, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
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 1:6200 ONTARIO CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14520-0155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 ONTARIO CENTER ROAD
Practice Address - Street 2:
Practice Address - City:ONTARIO CENTER
Practice Address - State:NY
Practice Address - Zip Code:14520
Practice Address - Country:US
Practice Address - Phone:315-524-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY764032163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool