Provider Demographics
NPI:1912103375
Name:PARKER, DANA
Entity Type:Individual
Prefix:MISS
First Name:DANA
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:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-1298
Mailing Address - Country:US
Mailing Address - Phone:252-442-8040
Mailing Address - Fax:252-451-8050
Practice Address - Street 1:854 TIFFANY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1949
Practice Address - Country:US
Practice Address - Phone:252-442-8040
Practice Address - Fax:252-451-8050
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2881376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408335Medicaid