Provider Demographics
NPI:1205811189
Name:PARKE, CYNTHIA M (CNM, MSN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:PARKE
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 YERMO DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2130
Mailing Address - Country:US
Mailing Address - Phone:419-474-9818
Mailing Address - Fax:419-841-8458
Practice Address - Street 1:7135 SYLVANIA AVE
Practice Address - Street 2:BUILDING 1 SUITE C
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3530
Practice Address - Country:US
Practice Address - Phone:419-843-4836
Practice Address - Fax:419-841-8458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34190888367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188710Medicaid
OH0188710Medicaid
OHS05956Medicare UPIN