Individual
LAKISHA SHANTAYE PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4200 EMERALD DR, BRIDGEPORT, MI 48722-9520
(989) 372-3691
Mailing address
339 S 25TH ST, SAGINAW, MI 48601-6337
(989) 372-3691
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703117282
MI
Other
Enumeration date
08/08/2019
Last updated
07/28/2025
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