Healthcare Provider Details

I. General information

NPI: 1629623335
Provider Name (Legal Business Name): PATRICK PARKER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DENNIS CHAVEZ BLVD SW
ALBUQUERQUE NM
87121-5498
US

IV. Provider business mailing address

PO BOX 25704
ALBUQUERQUE NM
87125-0704
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-1458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR64935
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: