Most Relevant Information
Provider Data
| NPI Number: | 1003665019 |
| Provider Name: | IAVANA PARKER ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 25MT00217400 |
Most Important Dates
| Enumeration Date: | 05/14/2024 |
| Last Updated: | 05/14/2024 |
Provider Practice Location
74 WESTERN DR
HOWELL
NJ
077312736
Practice Location Phone/Fax
| Phone: | 8484599817 |
| Fax: |
Provider Mailing Location
74 WESTERN DR
HOWELL
NJ
077312736
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |