Provider Demographics
NPI:1053403733
Name:PARKS, DIANA CARMODY (RN MS CFNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CARMODY
Last Name:PARKS
Suffix:
Gender:F
Credentials:RN MS CFNP
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Other - Credentials:
Mailing Address - Street 1:7070 E DR N
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8562
Mailing Address - Country:US
Mailing Address - Phone:269-660-1670
Mailing Address - Fax:269-660-0666
Practice Address - Street 1:7070 E DR N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8562
Practice Address - Country:US
Practice Address - Phone:269-660-1670
Practice Address - Fax:269-660-0666
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI209364363LF0000X
MI4704209364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8320022OtherPHPSM
MIM97310020Medicare PIN