Provider Demographics
NPI:1700067824
Name:PARKER, ANITA A (PA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:A
Other - Last Name:PAWELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1631 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3501
Mailing Address - Country:US
Mailing Address - Phone:248-458-0400
Mailing Address - Fax:248-458-0310
Practice Address - Street 1:15979 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5361
Practice Address - Country:US
Practice Address - Phone:586-247-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant