Provider Demographics
NPI:1780492264
Name:PARKER, SANDRA MARIE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
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 1:128 CORIANDER WAY
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-3615
Mailing Address - Country:US
Mailing Address - Phone:304-620-1423
Mailing Address - Fax:
Practice Address - Street 1:128 CORIANDER WAY
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-3615
Practice Address - Country:US
Practice Address - Phone:304-620-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant