Individual
CLINTEN LEE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3710 BRISTOLWOOD CT, GRIMESLAND, NC 27837-9269
(252) 916-6080
Mailing address
3710 BRISTOLWOOD CT, GRIMESLAND, NC 27837-9269
(252) 916-6080
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
169240
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
074452
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052941
—
NC
01
—
P00601414
RAILROAD MEDICARE
NC
Enumeration date
05/09/2007
Last updated
10/07/2010
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