Healthcare Provider Details

I. General information

NPI: 1154392496
Provider Name (Legal Business Name): REBECCA SUZANNE PARKER RN, MN, CNM, FNP.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 OAK ST
ASHLAND OR
97520-1263
US

IV. Provider business mailing address

796 OAK ST
ASHLAND OR
97520-1263
US

V. Phone/Fax

Practice location:
  • Phone: 503-819-3712
  • Fax: 541-708-0230
Mailing address:
  • Phone: 503-819-3712
  • Fax: 541-708-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200150132NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number91007142
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP 30004962
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1876
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004962
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: