Healthcare Provider Details

I. General information

NPI: 1497726053
Provider Name (Legal Business Name): MARLYCE E PARKER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 SILVER CREEK RD SUITE A
BULLHEAD CITY AZ
86442-8227
US

IV. Provider business mailing address

5525 S WISHING WELL WAY
FORT MOHAVE AZ
86426-8880
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-6741
  • Fax: 928-704-6779
Mailing address:
  • Phone: 702-985-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN000821
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP3966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: