Provider Demographics
NPI:1144685264
Name:PARKS, NIKKI (LPN)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:PARKS
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 1:1012 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6506
Mailing Address - Country:US
Mailing Address - Phone:302-734-9040
Mailing Address - Fax:855-490-1542
Practice Address - Street 1:1012 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6506
Practice Address - Country:US
Practice Address - Phone:302-734-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0012286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse