Healthcare Provider Details

I. General information

NPI: 1649418096
Provider Name (Legal Business Name): MARK B PARSHALL PH.D., R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 MARBLE AVE NE MSC 09 5350 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2502 MARBLE AVE NE MSC 09 5350 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4540
  • Fax: 505-272-8901
Mailing address:
  • Phone: 505-272-4540
  • Fax: 505-272-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR24679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: