Provider Demographics
NPI:1326848409
Name:PARKER, LYNETTE RENEE
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:RENEE
Last Name:PARKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 HENNINGER DR #507
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-6810
Mailing Address - Country:US
Mailing Address - Phone:402-301-9502
Mailing Address - Fax:
Practice Address - Street 1:4131 SPRAQUE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-6810
Practice Address - Country:US
Practice Address - Phone:402-301-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty