Individual
CAROL LYNN PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 E COOLSPRING AVE, 2-E, MICHIGAN CITY, IN 46360-6312
(219) 879-6531
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002473A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200923670
—
IN
Enumeration date
08/24/2007
Last updated
03/11/2021
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