Provider Demographics
NPI:1861208498
Name:PARKER, SHANESEE RENEE
Entity type:Individual
Prefix:
First Name:SHANESEE
Middle Name:RENEE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANESEE
Other - Middle Name:RENEE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 S NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2257
Mailing Address - Country:US
Mailing Address - Phone:220-219-9321
Mailing Address - Fax:
Practice Address - Street 1:398 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5549
Practice Address - Country:US
Practice Address - Phone:614-224-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator