Basic Information
| Provider Information | |||||||||
| NPI: | 1184135915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKHAM | ||||||||
| FirstName: | JEANINE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 WILLIAM ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011052324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344072500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 S GULLEY RD STE F | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344072500 | ||||||||
| FaxNumber: | 3137928962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2017 | ||||||||
| LastUpdateDate: | 10/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704226052 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.