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NPI Code Detail

MEDICARE: SHELLY ANN PARKER NP

MEDICARE:   SHELLY ANN PARKER  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF07181909AZ

General Provider Information

NPI Number : 1689156671
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY ANN PARKER NP
Provider Business Mailing Address
First Line : 21190 E PROSPECTOR PL
Second Line :
City : RED ROCK
State : AZ
Zip : 85145-5017
Country : US
Telephone Number : 520-271-6142
Fax Number :
Provider Business Practice Location Address
First Line : 20414 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-3250
Country : US
Telephone Number : 615-224-5188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 09/05/2018

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