Individual
RYAN PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
6812 STATE ROUTE 162 STE 202, MARYVILLE, IL 62062-8562
(618) 288-6844
Mailing address
6812 STATE ROUTE 162 STE 202, MARYVILLE, IL 62062-8562
(217) 313-6566
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.018533
IL
363LF0000X
Family Nurse Practitioner
209.018533
IL
Other
Enumeration date
12/14/2018
Last updated
06/11/2019
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