Healthcare Provider Details

I. General information

NPI: 1841050317
Provider Name (Legal Business Name): BRIAN SCOTT PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

11394 E PRINCE RD
TUCSON AZ
85749-9039
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-3071
  • Fax:
Mailing address:
  • Phone: 843-460-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number258214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: