Basic Information
| Provider Information | |||||||||
| NPI: | 1043880115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | NOELLE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49433 S MEADOWBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | EAST LIVERPOOL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439209675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303281153 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6001 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432131502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145520089 | ||||||||
| FaxNumber: | 6145520168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 435694 | OH | N | Nursing Service Providers | Registered Nurse | 367500000X | APRNCRNA0020474 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.