Healthcare Provider Details

I. General information

NPI: 1285985242
Provider Name (Legal Business Name): BRENDA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MALTA LN
NORTH SYRACUSE NY
13212-2375
US

IV. Provider business mailing address

100 MALTA LN
NORTH SYRACUSE NY
13212-2375
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-5800
  • Fax:
Mailing address:
  • Phone: 315-452-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355210-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number298833-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: