Provider Demographics
NPI:1104412808
Name:PARKS, DIANE ALLEGRA (RN, BSN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ALLEGRA
Last Name:PARKS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ALLEGRA
Other - Last Name:HOEFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-5579
Mailing Address - Country:US
Mailing Address - Phone:915-252-6806
Mailing Address - Fax:
Practice Address - Street 1:35 APACHE TRL
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856-5579
Practice Address - Country:US
Practice Address - Phone:915-252-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX928752163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse