Provider Demographics
NPI:1104472604
Name:PARKER, NORMAN A JR
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:A
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 STREAMWAY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-1966
Mailing Address - Country:US
Mailing Address - Phone:910-977-9311
Mailing Address - Fax:
Practice Address - Street 1:1018 STREAMWAY DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-1966
Practice Address - Country:US
Practice Address - Phone:910-977-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education