Provider Demographics
NPI:1306569298
Name:PARKER, TANYA (RN, IL ECRN, PEL)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, IL ECRN, PEL
Other - Prefix:MS
Other - First Name:TAN'YA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SCHOOL NURSE
Mailing Address - Street 1:PO BOX 8412
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7015
Mailing Address - Country:US
Mailing Address - Phone:224-480-7795
Mailing Address - Fax:847-628-2321
Practice Address - Street 1:33661 N ROYAL OAK LN APT 208
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2810
Practice Address - Country:US
Practice Address - Phone:847-752-8881
Practice Address - Fax:847-628-2321
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.344115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse