Individual
ANNETTE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2525 S MICHIGAN AVE, MEDICAL STAFF OFFICE, CHICAGO, IL 60616-2315
(312) 567-6510
Mailing address
4551 N MERRIMAC AVE, CHICAGO, IL 60630-3017
(773) 283-6781
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209002952
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209002952
IL STATE LICENSE
IL
01
—
950150
MERCY MEDICAL GROUP MEDICARE PTAN
—
01
—
950150046
MEDICARE PTAN
IL
Enumeration date
11/27/2007
Last updated
05/04/2016
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