Provider Demographics
NPI:1194066118
Name:PARKER, JODI LEANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5892 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1830
Mailing Address - Country:US
Mailing Address - Phone:440-225-0041
Mailing Address - Fax:
Practice Address - Street 1:13900 DETROIT AVE
Practice Address - Street 2:LAKEWOOD SENIOR HEALTH CAMPUS
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4624
Practice Address - Country:US
Practice Address - Phone:216-228-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN133689164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse