Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3006961 | KY |
NPI | 1003102716 |
---|---|
Provider Name | Mrs. Denisa Dawn Parker |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40217-1385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 08/10/2021 |