Healthcare Provider Details

I. General information

NPI: 1417122656
Provider Name (Legal Business Name): GARY ALBERT PARKINSON EMT-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 ONEIL LN
EUREKA CA
95503-4870
US

IV. Provider business mailing address

2828 ONEIL LN
EUREKA CA
95503-4870
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9385
  • Fax: 707-443-0258
Mailing address:
  • Phone: 707-443-9385
  • Fax: 707-443-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number07001184
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number95171768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: