Provider Demographics
NPI:1194495564
Name:PARKER, IANA LEEANN
Entity type:Individual
Prefix:MS
First Name:IANA
Middle Name:LEEANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IANA
Other - Middle Name:LEEANN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1505
Mailing Address - Country:US
Mailing Address - Phone:413-221-7544
Mailing Address - Fax:
Practice Address - Street 1:16900 N BAY RD
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4252
Practice Address - Country:US
Practice Address - Phone:413-221-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251V00000XAgenciesVoluntary or Charitable