Healthcare Provider Details

I. General information

NPI: 1275716268
Provider Name (Legal Business Name): DEANN LORRAINE PARKER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 SE MARKET ST
PORTLAND OR
97216-2532
US

IV. Provider business mailing address

21325 S LEWELLEN RD
BEAVERCREEK OR
97004-9736
US

V. Phone/Fax

Practice location:
  • Phone: 503-257-2500
  • Fax:
Mailing address:
  • Phone: 503-632-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: