Provider Demographics
NPI:1447475454
Name:GARRIOTT-PARKS, ANNETTE RACHELLE (RD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RACHELLE
Last Name:GARRIOTT-PARKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 N US HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9468
Mailing Address - Country:US
Mailing Address - Phone:317-769-4109
Mailing Address - Fax:
Practice Address - Street 1:2032 N US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9468
Practice Address - Country:US
Practice Address - Phone:317-769-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered