Healthcare Provider Details

I. General information

NPI: 1922098102
Provider Name (Legal Business Name): MARCIA DEBRA PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARCIA DEBRA KINSELLA

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 OAKINGTON ST KIRK US ARMY HEALTH CLINIC
ABERDEEN PROVING GROUND MD
21005-5131
US

IV. Provider business mailing address

2501 OAKINGTON ST KIRK US ARMY HEALTH CLINIC
ABERDEEN PROVING GROUND MD
21005-5131
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-1986
  • Fax: 410-278-1783
Mailing address:
  • Phone: 410-278-1986
  • Fax: 410-278-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR092537
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: