Healthcare Provider Details

I. General information

NPI: 1043560055
Provider Name (Legal Business Name): CATHY ANN PARKER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13007 NE GLISAN ST
PORTLAND OR
97230-2545
US

IV. Provider business mailing address

13007 NE GLISAN ST
PORTLAND OR
97230-2545
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-7866
  • Fax: 503-215-7864
Mailing address:
  • Phone: 503-215-7866
  • Fax: 503-215-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number082010490
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: