Provider Demographics
NPI:1770532772
Name:PARKS, ANNE TRIEBER (ANPC)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:TRIEBER
Last Name:PARKS
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 RAYMOND CT
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-8069
Mailing Address - Country:US
Mailing Address - Phone:847-515-1505
Mailing Address - Fax:888-519-7315
Practice Address - Street 1:12040 RAYMOND CT
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-8069
Practice Address - Country:US
Practice Address - Phone:847-515-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004709363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS50235Medicare UPIN