Provider Demographics
NPI:1487049581
Name:PARKS, ROSE ANTOINETTE (DO)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANTOINETTE
Last Name:PARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 S BUCKNELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4135
Mailing Address - Country:US
Mailing Address - Phone:252-702-9418
Mailing Address - Fax:
Practice Address - Street 1:1270 S BUCKNELL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4135
Practice Address - Country:US
Practice Address - Phone:252-702-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program