Provider Demographics
NPI:1427496090
Name:PARKER, SANDRA ANN (RD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W. MITCHELL STREET
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-3118
Mailing Address - Fax:231-487-3454
Practice Address - Street 1:560 W. MITCHELL STREET
Practice Address - Street 2:SUITE 160
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-3118
Practice Address - Fax:231-487-3454
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered