Individual
MRS. JACQUELINE PHYLLIS PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1092
Mailing address
716 COUNTY ROAD 8, CORUNNA, IN 46730-9756
(260) 318-1046
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28179527A
IN
Other
Enumeration date
05/31/2022
Last updated
05/31/2022
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