Provider Demographics
NPI:1366064651
Name:PARNELL, DONNA (CPSS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PARNELL
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-0666
Mailing Address - Country:US
Mailing Address - Phone:567-312-2155
Mailing Address - Fax:
Practice Address - Street 1:214 N CHRISTINE CIR
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1509
Practice Address - Country:US
Practice Address - Phone:810-637-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health