MEDICARE: MARYELLEN PARKER FNP

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
1	363LF0000X	Family Nurse Practitioner	201501459NP-PP	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201501459NP	OR

General Provider Information

NPI Number	:	1861742025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN PARKER FNP

Provider Business Mailing Address
First Line	:	70 SW CENTURY DR STE 100
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3558
Country	:	US
Telephone Number	:	541-293-5239
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 NW GREELEY AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2911
Country	:	US
Telephone Number	:	541-293-5239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	07/01/2026

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